The Labor and delivery room in the main government hospital in downtown Port Au Prince is a single room with 25 or so metal beds placed 5 feet apart all facing center. There are 2″ thick pads on the bed that are wiped off with a towel in between patients. Nurses, six of them, stand in the middle of the room chatting and wait until they determine a woman’s cries to be indicative of impending birth, at which point they rush over with the sole OB physician, and deliver the baby. The baby is suctioned and toweled off by the nurses and handed back to the mother who will go home 6 hours later.
Pediatricians are not present during the delivery, however if a baby comes out sick, or still, the nurse runs out of the room, out of the clinic, through the front gate, down to the end of the street and into the pediatric clinic where she must roam around looking for a physician who is able to leave his or her current patient. The summoned physician then briskly walks back along the nurse’s path to the OB clinic to assess the situation. There is no vacuum suction, no oximeters, no oxygen, no x-ray, no ultrasound and no specialists.
Outside the delivery room is a long line of women sitting in chairs as though waiting to use the restroom, except they are waiting to get in to deliver. According to one nurse, many women deliver out in the waiting area.
Saving you further descriptive details of the birthing process in this common room, I want to say that privacy was not an element of the patient’s experience. And more importantly, no one seemed to care. I thought about the ways in which we could improve the delivery process for the women here, would providing them more privacy serve any benefit? Of the many ideas I had to improve their care (i.e. more training for the MD’s, availability of specialists, supplies, etc. etc.), privacy was not a consideration. Apparent, for example in the debate on the security of online PHRs, patient confidentiality and improving privacy is a major focus in the US healthcare system. Why? Do we have such an excess of resources to analyze, change, and implement that we go searching for elements of care to improve?
I returned to a country consumed with the debate on our healthcare system, and I found myself annoyed with its complexity. As I returned to my public health courses, and I learned more and more about our system, I knew that my opinions and involvement were altered because of my experience with a simpler, less convoluted system.