SANTO DOMINGO, Dominican Republic, November 23, 2014 (AMG) — A report conducted last month by Altagracia Guzman Marcelino, the Dominican Republic’s new Minister of Health, found that the deaths of 11 babies in one weekend at Robert Reid Cabral Hospital in Santo Domingo was a tragic, but not unusual occurrence.
What happened: On October 3, 2014, two babies died followed by four on Saturday and five on Sunday. Three of the infants were newborns, five were less than a year old and three were older than a year. One mother, Rosa Elba Santana, lost her twins Rosanna and Isaac after taking them to the hospital for what she believed were minor illnesses. She has been left at a loss to explain her devastation.
National outrage followed as the former hospital director, Rosa Nieves Paulino, explained that while there had been a fault in the ICU’s oxygen system and two elevators were out of service, it had “nothing to do with the deaths” of the babies. She insisted that staff were trained in operating manual ventilators and that the children were already in a critical condition. Paulino has since been replaced by Dr. Jose Miguel Ferreras as a result of the deaths.
With an initial report finding that causes of death included infections contracted in the hospital, and deficiencies in the quality of medical care – including faulty respirators – attention has turned to how this could have happened in one of the Dominican Republic’s busiest and well known hospitals.
[highlight text=”Sidebar 1: Infant mortality rate (per 100,000 live births) in 2013 compared to 2003 for all Caribbean islands where data is available. Source: World Bank databank”]
| Rank | Country | 2003 | 2013 | % Change |
| 1 | Antigua and Barbuda | 11.8 | 7.7 | -53 |
| 2 | St. Kitts and Nevis | 11.6 | 7.8 | -49 |
| 3 | Suriname | 27.7 | 20.3 | -36 |
| 4 | Belize | 19.4 | 14.3 | -36 |
| 5 | Jamaica | 18.9 | 14.3 | -32 |
| 6 | Dominican Republic | 30.6 | 23.6 | -30 |
| 7 | Trinidad and Tobago | 24.6 | 19 | -29 |
| 8 | Dominica | 12.9 | 10.2 | -26 |
| 9 | Haiti | 68.7 | 54.7 | -26 |
| 10 | Guyana | 36.6 | 29.9 | -22 |
| 11 | Bahamas, The | 12.7 | 10.4 | -22 |
| 12 | Grenada | 13 | 10.7 | -21 |
| 13 | St. Lucia | 14.8 | 12.7 | -17 |
| 14 | Cuba | 5.8 | 5 | -16 |
| 15 | Barbados | 15.1 | 13.3 | -14 |
| 16 | St. Vincent and the Grenadines | 19.4 | 17.2 | -13 |
Health facilities overwhelmed: Dr. Pedro Sing, the President of the Dominican Medical College (DMC) has blamed the deaths on an “overwhelming” number of patients that have sought hospital services following an increase in referrals from private clinics and other hospitals. He went on the say that since January this year, the number of infant deaths at weekends has consistently been between 7 and 12, due to an inefficient primary health care system unable to meet the needs of the country’s poorest.
President Danilo Medino’s government had scrapped the ‘recovery-fee’ charged to patients leading to accusations they had introduced a policy that although popular, it couldn’t sustain. Robert Reid Cabral’s Children’s hospital sees around 13,000 people a year and survives on a budget of US$1.7 million – it reportedly relies on those fees to cover expenses.
[highlight text=”Sidebar 2: Percentage of government expenditure spent on health in 2012 compared to 2003. Source: World Bank databank”]
| Rank | Country | 2003 | 2012 | % Change |
| 1 | Jamaica | 4.5 | 10.7 | 137 |
| 2 | Antigua and Barbuda | 11.9 | 17.8 | 50 |
| 3 | Belize | 8.5 | 12.1 | 42 |
| 4 | Dominica | 7.9 | 10.4 | 32 |
| 5 | Guyana | 10.6 | 13.1 | 23 |
| 6 | St. Vincent and the Grenadines | 11.0 | 12.5 | 14 |
| 7 | St. Kitts and Nevis | 6.3 | 7.1 | 13 |
| 8 | Cuba | 10.9 | 11.5 | 6 |
| 9 | St. Lucia | 9.7 | 10.3 | 6 |
| 10 | The Bahamas | 15.2 | 15.7 | 3 |
| 11 | Suriname | 12.0 | 11.9 | -1 |
| 12 | Grenada | 10.4 | 9.0 | -13 |
| 13 | Trinidad and Tobago | 8.9 | 7.6 | -15 |
| 14 | Dominican Republic | 17.0 | 14.3 | -16 |
| 15 | Barbados | 12.6 | 9.9 | -22 |
| 16 | Haiti | 13.4 | 5.5 | -59 |
Government spending: While infant mortality has fallen by 30% in the Dominican Republic since 2003, the percentage of GDP spent on health by the government has fallen by 20% in the same time period; more than any other country in the region. The percentage of government expenditure spent on public health has fallen by 16% in the same time period, suggesting a shift away from prioritizing health care despite the recent removal of recovery-fee charges and apparent need for additional funding.
Money was awarded in September 2013 to the Ministry of Public Health and Social Assistance from the Inter-American Development Bank (IDB) for US$146 million, of which approximately US$50.5 million has been received to date. The purpose was to fund a program to strengthen health services management specifically for maternal and child health. The claim that 11 infant deaths in one weekend falls within the normal range observed since January 2014 begs the question of how and where this money is being spent, and to what effect.
[highlight text=”Table 3: Percentage of total GDP spent on health in 2012 compared to 2003. Source: World Bank databank”]
| Rank | Country | 2003 | 2012 | % Change |
| 1 | St. Kitts and Nevis | 3.7 | 5.9 | 37 |
| 2 | St. Lucia | 6.2 | 8.5 | 27 |
| 3 | Cuba | 6.3 | 8.6 | 26 |
| 4 | The Bahamas | 5.6 | 7.5 | 25 |
| 5 | St. Vincent and the Grenadines | 3.9 | 5.2 | 25 |
| 6 | Jamaica | 4.6 | 5.9 | 23 |
| 7 | Belize | 4.5 | 5.8 | 22 |
| 8 | Haiti | 5.3 | 6.4 | 17 |
| 9 | Dominica | 4.9 | 5.9 | 16 |
| 10 | Guyana | 5.6 | 6.6 | 15 |
| 11 | Antigua and Barbuda | 4.4 | 5.2 | 15 |
| 12 | Trinidad and Tobago | 5.1 | 5.4 | 6 |
| 13 | Grenada | 6.2 | 6.4 | 3 |
| 14 | Barbados | 7.1 | 6.3 | -12 |
| 15 | Suriname | 6.6 | 5.9 | -13 |
| 16 | Dominican Republic | 6.5 | 5.4 | -20 |
Warning against complacency: Health care spending has increased per capita in almost all Caribbean states, although in some cases it has decreased as a percentage of government expenditure or GDP. If this is indicative of a shift in priorities, recent events in the Dominican Republic should serve as a warning that continued progress in reducing infant mortality rates rely on continued investment in primary and tertiary health facilities.
For Rosa Elba Santana and the families of other Dominican and Haitian babies who have died due to substandard care or facilities, little comfort can be had from the results of investigations carried out so far.
It is Medino’s responsibility to listen to leading health professionals and prevent further tragedy.
Image: Attorney General of the Dominican Republic , Francisco Dominguez Brito , coordinator of the commission appointed by President Danilo Medina to investigate the deaths of children in the Robert Reid Cabral hospital, presents the final report of that committee.
Credit: Office of the President of the Dominican Republic
