This week, I had the privilege of observing maternal and neonatal care at Los Mina Hospital. We began this week in the kangaroo care unit, where I met Dr. Adalia De La Cruz and Dr. Guillermina Nadal. Kangaroo care involves placing premature babies skin-to-skin against the mother’s chest, promoting body warmth, reducing reflux and regurgitation, and promoting breastfeeding. These benefits stem from both a biological and emotional connection between the mother and child. Dr. Nadal explained that the increased breastfeeding seen with kangaroo care stems from the psychological impact of the mother’s physical contact with her baby. She acknowledged there may not be a specific scientific explanation for all of its benefits, instead describing it as “a gift from God.”
I also visited the breastfeeding support room, where nurses help mothers navigate feeding challenges without relying on technology. I learned about methods like using a suction syringe for inverted nipples and applying expressed breast milk to aid healing. They emphasized their reliance on manual methods, which they felt has worked well.
Still, this approach differs from what I’ve heard from Dr. Floren, President of the Dominican Foundation for Mothers and Infants, who expressed concern that many preterm infants may appear to feed adequately but still remain undernourished. In the U.S., babies typically aren’t put to the breast until they reach 1,700 grams and are monitored closely for weight gain. Here, the ability to suck is the main indicator for initiating breastfeeding. Dr. Floren emphasized that beyond survival, we need to ensure optimal nutrition to support neurological development. She believes in a more gradual, carefully tracked approach to feeding—introducing by mouth only when babies are ready, and verifying weight trends closely.
This contrast led me to reflect on many questions: Could babies be going home undernourished without the clinic realizing it? Is there a gap between maternal bonding and confidence and objective nutritional outcomes? And if so, how can we bridge this gap and maintain the strengths of the kangaroo care model while supporting optimal nutrition.
On Wednesday morning, we observed an ophthalmologist screening infants for Retinopathy of Prematurity (ROP). Using an indirect ophthalmoscope and handheld lens in a darkened room, she carefully examined the babies’ retinas for abnormal vessel growth. Mature eyes should have retinal vessels that start at the center of the retina and grow outward towards the edges (periphery). However, with preemie babies, they have an immature retina in which the vessels haven’t finished growing to the periphery. If the baby is exposed to too much oxygen while in the incubator, their vessel development
will be abnormal and can grow out of control. As the body tries to repair the abnormal vessels, scarring and contraction can occur, pulling on the retina and leading to retinal detachment, which can cause permanent blindness if untreated.
Afterward, we toured the labor and delivery unit with Dr. Valdez, a third-year OB/GYN resident. She showed us where mothers labor, deliver, and recover, as well as the area for post-abortion care and uterine biopsies. We also saw simulation models used for training residents in procedures such as laparoscopic surgery, which involves inserting a laparoscope, which is like a lighted camera, through the belly button and using surgical tools through a secondary incision. I’m hoping to observe these procedures, in addition to childbirth, in the coming weeks.
These experiences are also helping inform my work towards the infant breastfeeding monitor. Observing babies latch and watching the coordination of sucking, swallowing, and breathing in real time has been invaluable. It’s helped me better understand the nuances of breastfeeding and the challenges mothers and infants face.
Over these last several days, I’ve also noticed a striking difference from the US, which is the reliance on manual documentation. Everything from patient records to lab results is recorded with pen and paper in a book. While there’s interest in digitizing systems in the future, the current model reflects a workflow that has persisted for decades. Yet despite the lack of digital tools, the care provided was thorough and compassionate.
We ended Friday with a meeting between DOFMI and UNAPEC to discuss our collaboration. Our focus was on kangaroo care and the current use of heat lamps as substitutes for incubator lights, which are often unavailable in many hospitals across the Dominican Republic. While these lamps offer a source of warmth for premature babies, they carry potential safety concerns. We explored how integrating temperature, humidity, and oxygen saturation sensors could help monitor the babies’ environment more effectively and regulate the warmth being delivered. These sensors could guide proper lamp positioning to prevent overheating or underheating. We discussed how these same sensors could also be applied during kangaroo care to monitor the baby’s body temperature. These conversations have left me excited for what lies ahead.
Overall, this week deepened my appreciation for the resourcefulness and dedication of providers working with limited tools. It has reinforced how important it is to understand care in diverse settings and staying open to different approaches. While tools and protocols may vary, the goal remains the same: to care for each patient with dignity, safety, and compassion.
Here are some photos from last week’s tour of Los Mina Hospital, a cacao making workshop we attended over the weekend, and lunch with UNAPEC on Friday!
