The Longest Bus Ride

Jenny Foster, Hunter Keys

Jenny Foster thought that helping nurses in the Dominican Republic keep track of new mothers and their babies was the perfect project for her nursing students. MSN/MPH student Hunter Keys, who accompanied Foster to the Dominican Republic last year, is studying the mental health of Haitians who migrated there.

Checking up on new mothers and babies in rural Dominican Republic is no small feat

Riding on a bus down a bumpy dirt road in a rural area of the Dominican Republic, the Emory nursing students bounce in their seats. They are helping nurses at a nearby hospital keep track of mothers who recently gave birth to pre-term babies. When the bus reaches its destination several hours later, the students spread out around town to track down the names on their list. As in many developing countries, addresses in the rural countryside are known by word of mouth, and the students ask any neighbor they find if they know the mother.

The aspiring nurses are spending their semester break in the country's third largest city, San Francisco de Macorís, and are led by faculty members Jenny Foster PhD FACNM CNM MPH, a midwife with a doctorate in medical anthropology; Safiya Dalmida 01MN 06G  APRN-BC, a nursing expert in spirituality and health; and Sara Pullen DPT MPH CHES, an Emory School of Medicine physical therapist committed to serving HIV/AIDS patients.

The challenges facing nurses in the Dominican Republic are not new to Foster, who has worked there for a number of years. Few paved roads, limited financial resources, and a transient health workforce have made following the mothers difficult. Foster thought helping locate the mothers and perform well-baby checkups would be the perfect project for her student nurses.

"It's been difficult to get data because we can't find the mothers," says Foster. "The real-life challenges have been huge—cell phones get disconnected, locating the homes is difficult—so it's a work in progress." 

These mothers were taught in the hospital to use the "kangaroo mother" technique—skin-to-skin contact between mother (or another caretaker) and baby 24 hours a day. Most of the kangaroo babies were thriving, the students found.

"It empowers the mothers—you can see it in their eyes," Foster says. "They are so proud to see their babies grow and thrive."

The students also conducted a role-playing workshop for volunteer doulas to refresh their knowledge. The drama proved popular—the nurses and residents at Hospital San Vicente de Paul in San Francisco de Macorís also watched it.

Foster is known among the nurses there for helping them reduce maternal deaths in recent years. Despite a large network of public hospitals with trained staff and approximately 97 percent of pregnant women giving birth in hospitals, women were still dying. Foster helped the nurses determine that maternal deaths usually occurred because mothers were unable to get appropriate care in a timely manner.

At Foster's recommendation, the Dominican nurses attended a number of educational conferences to update their skills and made a plan to increase patient follow-up through more proactive behavior on the labor ward. The nurses also trained community health workers who can identify early warning signs to help pregnant women in rural areas seek medical care earlier.

Out of Foster's partnership with the nurses came a project to give cell phones to pregnant women to track them to prevent maternal and newborn deaths. She also is seeking funding for a study on teamwork skills and communication for urban and rural areas in the Dominican Republic.

Hunter Keys 13MSN/MPH, a student who traveled with Foster during semester break last year, is completing a different study on the mental health of Haitian migrants. He was drawn to the subject after taking part in an earlier public health study in Haiti on mental health. Haitian migrants in the Dominican Republic, he learned, face a host of issues: homesickness, language barriers, racial discrimination, and a lack of documentation, which often leads to their exploitation. Though he observed that many migrants couldn't access health care because of financial restraints, he did find a strong family and community network to care for those with mental health issues. He also leads an interdisciplinary team of students, funded by a grant from the Emory Global Health Institute, to study the impact of cholera on the relationship between Haitian migrants and Dominicans.

"Eventually, I would like to see Haitians and Dominicans engaged in what's called 'té ansanm,' which means 'heads together' in Haitian Kreyol," says Keys. "The migrants expressed a desire to do a té ansanm with their Dominican neighbors, so hopefully both groups can come together and really get to know one another. I think they would find they have a common goal—working for the betterment of their community."—Kay Torrance

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