SANTO DOMINGO, Dominican
Republic (AP) — Rosa Elba Santana struggles to comprehend what went
tragically wrong for her infant twins at the Robert Reid Cabral
Children's Hospital, one of the few places for someone with a sick kid
and not much money in the Dominican capital.
Rosanna and Isaac died, according to their death
certificates, from a bacteriological infection. But the clinical
explanation only raises more questions for Santana, who took the
month-old twins to the state-run hospital because the girl had stomach
pains and the boy seemed to have trouble breathing.
"I took them
to be checked, not because it was serious," the 20-year-old mother said
in a sparsely furnished home with a dirt floor where she is living with
her toddler son, mother and a sister. "Instead of getting better, they
got worse."
Her twins were
among 11 babies who died at Robert Reid Cabral over three days in early
October, a cluster of deaths that shocked Dominicans and brought what
some say is long-overdue attention to one of the country's most
important medical institutions. It also raises questions about overall
quality of health care for the poor in the Dominican Republic.
Following
the deaths, President Danilo Medina appointed a commission to
investigate. It found significant shortcomings at the hospital, leading
to the firings of the nation's health minister, the hospital director
and others, even as officials have defended the overall care at the
300-bed facility.
The commission, led by the attorney general,
determined in a preliminary investigation that infections contracted in
the hospital were responsible for the deaths of four of the 11 children,
including Santana's twins. Four other deaths stemmed from "deficiencies
in the quality" of medical care, including a failure that lasted
several hours in the system that supplies oxygen to the hospital's
respirators. In only one of the deaths did the patient receive adequate
treatment, their report found.
In this Oct. 15, 2014 photo, people leave and enter the Robert Reid Cabral Children's Hospital i …
The ousted director, Rosa Nieves Paulino, who was deputy
director for seven years before moving to the top job when Medina took
office in 2012, sought to defend her tenure by noting that the
hospital's mortality rate declined in recent years. Even so, the death
rate is three times the national average for public hospitals and there
were at least two other clusters of deaths there since June.
"The
children who come to the hospital are very sick. And, of those who died,
some of them had been here less than 24 hours," she said.
There
could be other factors behind the mortality rate, including the fact the
hospital treats children who are poorer and sicker than the overall
population. There isn't enough data to determine if the number of deaths
is "alarming," said the new director, Jose Miguel Ferreras.
"We can't say three or four deaths per day is a high figure without a deeper analysis," Ferreras said.
Still,
officials and doctors concede the hospital is understaffed, underfunded
and overfilled. Santana recalls there were four other babies crowded
onto the same bed as her twins when she took them there to be checked
out. Ferreras, however, said that only occurs in the emergency room, not
after patients have been admitted.
In this Oct. 15, 2014, children share beds in the Emergency Room of the Robert Reid Cabral Children& …
The Dominican Republic has pockets of extreme wealth but it
still largely is a poor country of 10 million. UNICEF says widespread
malnutrition is primarily responsible for the country's infant mortality
rate of 27 per 1,000 births. The average for all of Latin America and
the Caribbean is 16 per 1,000, according to the Pan American Health
Organization.
Robert Reid Cabral opened in 1956 and is named for a
Dominican pediatrician and brother of a former president, but is
popularly known as "El Angelita" for its original name honoring Angelita
Trujillo, daughter of a former dictator. Because it accepts payments
from social security and is willing to treat the very poor at no cost,
it draws patients from throughout the country, including many who, like
Santana, live in slums on the outskirts of the capital.
"They told me this was the place to take your children, where they have the specialists," she said.
Sitting
on her tattered couch, Santana, who is single and has no job, tries to
make sense of the death certificates, which describe how her son died
while doctors tried to perform a blood transfusion to treat sepsis that
had overwhelmed his body. Her daughter died under similar circumstances
the next day. Prosecutors interviewed her for the commission's
investigation but she hasn't heard back from them. She doesn't know
whether she will receive any compensation for her loss.
Some
parents of other children who died invited her to take part in a protest
at the hospital but she declined. "I will never go back to El
Angelita," she said. "I'm afraid to go there."
Doctors and nurses
who work at Robert Reid Cabral say the main problem at the
government-funded hospital is a lack of resources. They have an annual
budget of just $1.7 million and admit about 13,000 patients a year.
Last
year, the government eliminated the minimum fee for patients lacking
health insurance or social security coverage and "there was an avalanche
in the demand for service," which strained the hospital even more, said
Dr. Martiza Lopez, the head of a committee of doctors that has pushed
to increase the budget.
Doctors and nurses at the hospital, like
counterparts in other parts of the country, repeatedly have gone on
strike over their dismal wages and working conditions. Doctors who are
specialists earn about $1,000 a month, and many must take side jobs to
get by. Some, like Dr. Radhames Ovalles, accuse of the government of
trying to win political points by expanding access to health care
without paying for it.
"The government should stop its rhetoric and begin to take care of the poorest," he said.