Thank you for coming along until our very last week of the internship! These 8 weeks have flown by, and It’s been an incredibly rich and rewarding experience.

From Saturday through Wednesday, I dedicated my time to working on a report for the reusable feeding syringe. I spent these days diving deep into research into understanding the background context and problem, as well as developing a methodology to test various reusable syringe models and cleaning protocols. This paper outlined the context and a methodology for studying and developing the syringe project.

Thursday and Friday, however, were quite different, as I shifted from research to hands-on shadowing at Circuimed in Santiago.

Thursday began early with an 8:30 AM Caribe bus ride from 27 de Febrero in Santo Domingo to Los Jardines in Santiago. Upon arriving, we took an Uber to Circuimed, where we spent the day immersed in medical equipment repair and maintenance. We worked with Bleidy George, who was fixing an electrocardiograph (ECG).

An ECG records the electrical activity of the heart by using electrodes placed on a patient’s skin. These electrodes capture electrical signals produced by the heart and send them to the machine, which amplifies and displays them as waveforms on a screen or prints them on paper. These waveforms are crucial for healthcare professionals to assess heart rhythms and monitor overall cardiac health.
The ECG we worked on had stopped functioning due to humidity getting inside the device and causing a short circuit. The source of the issue was the blown fuse, two small glass cylinders responsible for carrying electrical current, which we confirmed with a voltmeter. Testing across the fuse showed no current flow, indicating it needed to be replaced.

After restoring the ECG, Bleidy shifted his attention to a System 5000 Electrosurgical System, a device commonly used in operating rooms to cut tissue and stop bleeding during surgeries. This machine operates in two modes: cut and coagulation. The cut mode uses continuous, high-frequency current at higher voltage levels to vaporize cells quickly and make precise incisions. The coagulation mode employs pulsed current at lower voltage to slowly heat tissue, causing blood to clot and sealing blood vessels. We got to experiment with these modes by testing different voltages on a bar of soap, which was a great way to observe how the device functions practically.

The main issue with this electrosurgical device was that it often turned off unexpectedly during use, forcing doctors to pause procedures while waiting for it to restart. This instability clearly impacts workflow and patient care.

Later, we visited a private hospital clinic where Bleidy was installing pulse oximeters at patient bedsides. I noticed that each pulse oximeter was only compatible with monitors of the same brand, a business strategy that restricts cross-brand equipment use. While understandable from a commercial perspective, this practice unfortunately makes equipment access more complicated and costly for healthcare providers.

Friday’s day at Circuimed started with meeting Vladimir, who introduced us again to Anthony, who specializes in fixing ventilators. Anthony was working on a ventilator with a malfunctioning internal compressor. This component is responsible for filtering ambient air to produce medical air, which typically contains about 20% oxygen. For patients requiring higher oxygen levels, the ventilator mixes this medical air with pure oxygen using a blender, ensuring the delivered mixture meets the specific clinical needs.

Many hospitals in the Dominican Republic lack centralized medical air supplies through wall outlets, so ventilators must rely on these internal compressors. However, these compressors represent older technology and are mechanical in nature. More modern ventilators use turbines, which are smaller, quieter, more durable, and regulate airflow in real-time.

Anthony explained that when an internal compressor breaks, repairing it is often not cost-effective because the price of a new compressor is comparable to that of an entire ventilator. Instead, Circuimed salvages functional components from these incubators to keep other machines running.
Watching Anthony troubleshoot the ventilator was a great learning experience, offering insights extending into my personal project. For instance, to calibrate pressure sensors, he modified a syringe to have two tubing outputs, one connected to a pressure measuring device and the other to the sensor. By pulling back the syringe plunger, the pressure readings on both devices should match, allowing precise calibration. I saw the applications of this kind of procedure for calibrating the pressure sensor that would be used for my breastfeeding monitoring device.

Anthony also shared an important story about visiting a hospital that owned Comen incubators but continued using gooseneck lamps to keep newborns warm. The staff were unaware that the incubators had thermal mattresses capable of safely warming infants. This highlighted a critical need for educating hospital staff on the proper use of equipment to improve neonatal care and reduce risks associated with outdated practices.

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.

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!