Help Me With This Letter

[cobraboy]

It depends how they go about it - first of all it has to respond to an existing need that is recognised by at least some local professionals/potential service users, as opposed to an imposition by foreigners who think they know best. Cultivating alliances with professionals who are sympathetic or open to the idea is the way to approach it - as they seem to be doing in this case. It may not replace the current model but it can start off as a minority niche and the results ought to speak for themselves.

I agree with everything that Shalena and Laura have said about the prevailing attitudes here. There are however some gynaecologists who share her views on childbirth and breastfeeding and plenty of women too if the membership of La Leche League is anything to go by.

The Dominican healthcare system is centered 100% on doctors. Nurses are well down the food chain.

$$$ are scarce and when the docs in the country see that their income is in jeopardy they will call in the favors necessary to shut them down.

This group will be competing head to head with doctors with ~zero~ political or legal leverage. It's not hard to guess the outcome: they will be found guilty of practicing medicine without a license.

The smart thing to do is enlist a connected physician to be their local champion. This ain't Kansas...or Chapel Hill.

 

[SKing]

What you are trying to do is wonderful wish you success

Thats what we need! Prayers and well wishes. Thanks so much!

Shalena, I agree with Chrimoya. You need a one page summary - a sort of project proposal - and a "presentation letter" to accompany.

I would reduce the number of citations and give the information in as clear and concise a manner as possible. Most people would not want to slog through a letter heavy with citations and verbiage.

PM me if you would like more assistance or information.

LP

Yes, I am going to rewrite and see what you guys think of the second draft!

IMO, you're in for a heap of trouble without physicians being the champion in the DR.

Fine intentions, but you're treading on ground that others occupy...

We have had that thought from nother but don't think that we will have trouble and I will explain why. We think, and we may be incorrect...but we assume that our biggest clientele will be poor, low and middle income Dominicanas, and expats. Poor and low income because their only other choice is the public hospital, which we all know leaves much to be desired. Our rooms will be private with comfortable beds, sofa , rocking chair, TV and DVD, birthing tubs, etc, they will be able to eat and drink (food provided by the Birth Center), family is encouraged. Baby will ever be separated from Mom...etc typical Birth Center. Middle income that may have enough money to go to a clinica but still desire top notch one on one treatment and have some education so they know that what is best for them and baby. As there are some Dominicanas that hold these values. And expats as they are familiar with Midwives nd our standard of care.
So.... I don't think that HOMs or Las Corominas OBs wil lose many patients, at least not enoug to make a sgnificant impact on their revenue. The OBs that will be the most impacted are the ones in the public hospitals and believe me, they are welcoming the relief. Some have already agreed to be "back up" for us in case of any obstetrical emergency we may encounter. One has already contacted wanting to knw when the next "group" was coming. They are overworked, sometimes do not receive pay for 2-3 months, they have to sleep on sheetless patient beds on shifts because there are no call rooms forthem. They are welcoming us! Cabral y Baez on the regular hae 30-35deliveries per day! I'm sure they will not complain about a slight decrease. We will be a blessing to the doctors that are not private. They do not get extra $$$ forall of the extra deliveries that they do. They work like horses with little supplies and resources...we have gotten positive input from them!
We will take any negativity as it comes but the Docs that I think would be the ones to complain will not be as advrsely affected as one may think. I think one lady from the campo or barrio coming to our Birth Center is going to blow us up! They will say...."Cabral y Baez?!? Yo no voy pa'ya! Voy pa' la Casa de Parto.....esas Parteras te tratan como una reeeeeina! Preguntale a mi prima!"

SHALENA

 

[SKing]

It depends how they go about it - first of all it has to respond to an existing need that is recognised by at least some local professionals/potential service users, as opposed to an imposition by foreigners who think they know best. Cultivating alliances with professionals who are sympathetic or open to the idea is the way to approach it - as they seem to be doing in this case. It may not replace the current model but it can start off as a minority niche and the results ought to speak for themselves.

I agree with everything that Shalena and Laura have said about the prevailing attitudes here. There are however some gynaecologists who share her views on childbirth and breastfeeding and plenty of women too if the membership of La Leche League is anything to go by.

This is how we are doing it. We have connections in Cabral y Baez nd I have a friend who works for ProMedica who will be introducing meto manyDocs, not just OBs....we are nt there to change their views or take their patients we are there to give these women a choice. Right now too many women do not have a choice.
Again, we were very well recived in Cabral y Baez and the hospital I am going to in December alsosupports the idea, the head Midwife of that trip hs been taking students there since 1986.

SHALENA

 

[SKing]

The Dominican healthcare system is centered 100% on doctors. Nurses are well down the food chain.

$$$ are scarce and when the docs in the country see that their income is in jeopardy they will call in the favors necessary to shut them down.

This group will be competing head to head with doctors with ~zero~ political or legal leverage. It's not hard to guess the outcome: they will be found guilty of practicing medicine without a license.

The smart thing to do is enlist a connected physician to be their local champion. This ain't Kansas...or Chapel Hill.

We are doing this....again, we are not COMPETING, we are collaborating. And we re going through the Ministerio de Salud to have our papers in order....we are not going about this blindly.
But thanks because we need to consider any probems that may come about

SHALENA

 

[Chirimoya]

The Dominican healthcare system is centered 100% on doctors. Nurses are well down the food chain.

$$$ are scarce and when the docs in the country see that their income is in jeopardy they will call in the favors necessary to shut them down.

This group will be competing head to head with doctors with ~zero~ political or legal leverage. It's not hard to guess the outcome: they will be found guilty of practicing medicine without a license.

The smart thing to do is enlist a connected physician to be their local champion. This ain't Kansas...or Chapel Hill.

Unfortunately in the DR nurses are little more than maids in terms of their role, their knowledge and training, and their clout - but maybe it wasn't clear that I meant doctors when I mentioned "professionals" and "gynaecologists".

 

[LaLouve]

All the best SHALENA, great initiative and much needed!

 

[SKing]

BTW...I encourage everyone to go to websites of the World Health Organization and United Nations Population Fund. They are not playing anymore with maternal and infant mortality and they fully support access to trained Midwives in EVERY country. I am sure that if I could actually speak to someone of power in WHO, UNICEF, or the UN....and let them know our goals and that we will be the VERY FIRST BIRTH CENTER WITH MIDWIVES in the COUNTRY, we would be fully funded in everything.

SHALENA

 

[SKing]

All the best SHALENA, great initiative and much needed!

Thank you, God only knows how it will turn out....if we are outed....it won't be for lack of effort!

SHALENA

 

[La Profe_1]

IMO, you're in for a heap of trouble without physicians being the champion in the DR.

Fine intentions, but you're treading on ground that others occupy...

CB,

Your observation is correct, as far as it goes. However, from my years of working with Salud P?blica and free dental care, I have found that Shalena is also correct.

Doctors will care and make a fuss if the free clinic/center impacts upon their patient load. However, since Shalena is talking about serving the poor who have only the public hospitals as an option, the existence of her center won't really affect their bottom line.

The only possible issue I see is that if Shalena attracts expat patients, or patients from a higher socio-economic level, she might then find her center having a negative effect on the established physicians. That could be problematic.

It was the same with the dentists. As long as the patients seen were poor and unlikely to be able to pay a private dentist, there was absolutely no problem with treating between five and seven hundred patients in a week.

 

[SKing]

CB,

Your observation is correct, as far as it goes. However, from my years of working with Salud P?blica and free dental care, I have found that Shalena is also correct.

Doctors will care and make a fuss if the free clinic/center impacts upon their patient load. However, since Shalena is talking about serving the poor who have only the public hospitals as an option, the existence of her center won't really affect their bottom line.

The only possible issue I see is that if Shalena attracts expat patients, or patients from a higher socio-economic level, she might then find her center having a negative effect on the established physicians. That could be problematic.

It was the same with the dentists. As long as the patients seen were poor and unlikely to be able to pay a private dentist, there was absolutely no problem with treating between five and seven hundred patients in a week.

That is a relief to hear....although we will probably have some expat patients, I don't think that it will be enough to affect their revenue. Again, we will surely be attracting the patients that would normally go to the public hospital. We will not make money as even though we will have sliding scale payment for our services I don't most will be able to pay much. We will receive our measly salaries from what we charge students for the experience. Midwifery students have to have hundreds of skills documented and signed off. This is very difficult for some students who may live fat away from a Midwife to apprentice with. Currently MamaBaby Haiti charges $1,000 for a 2 week student volunteer spot. I am paying $600 for my one week in DR as hospitals on developing nations usually have more of our high risk skills to learn. On my trip, there will be 8 students.
So I'm hoping that the docs won't be too upset, and I don't expect that they will when they find out we're operating on donations and not making any real money at all!

SHALENA

 

[cobraboy]

Good luck.

But strategically, I suggest you cover your political bases more thoroughly.

Docs in the DR don't like competition. That was a complaint Shalena had in the first place.

YOU may think "collaboration", THEY make think "competition", especially if you start to tell folks the opposite of what the local medical wisdom dictates. Competition can be intellectual, pride and ego. It's not always about the $$$.

This is different than dentistry because dentistry is not a public "right" like doctoring is. And the public health dept. in the DR is far down the political food chain.

Just sayin'...

 

[SKing]

Good luck.

But strategically, I suggest you cover your political bases more thoroughly.

Docs in the DR don't like competition. That was a complaint Shalena had in the first place.

YOU may think "collaboration", THEY make think "competition", especially if you start to tell folks the opposite of what the local medical wisdom dictates. Competition can be intellectual, pride and ego. It's not always about the $$$.

This is different than dentistry because dentistry is not a public "right" like doctoring is. And the public health dept. in the DR is far down the political food chain.

Just sayin'...

Thank you... I will keep all of this in mind

SHALENA

 

[SKing]

Watch these 2....you will want to support

BlackPlayer

and

BlackPlayer

 

[LaLouve]

Thank you, God only knows how it will turn out....if we are outed....it won't be for lack of effort!

SHALENA

Step by step, it will be worth it and it will work! Because, mothers and their babies will be the proof that the idea and the services are essential. All the best!

 

[SKing]

CB...do you suggest we attemptto make nice with a politician bcause it would be close to impossible to get near any. I guess what I mean is,in addtion to the caution, could you give me some ideas of what to do....where to go...who to speak to?

SHALENA

 

[cobraboy]

CB...do you suggest we attemptto make nice with a politician bcause it would be close to impossible to get near any. I guess what I mean is,in addtion to the caution, could you give me some ideas of what to do....where to go...who to speak to?

SHALENA

Find a champion to do it for you.

 

[Alyonka]

I have done some work for this organization: AIHA - What We Do

They seem to have goals, similar to yours. You can contact them for help with the letter and fundraising. They have a lot of experience.

Here is a program similar to yours: http://www.aiha.com/en/WhatWeDo/Nursing.asp

Good luck!

 

[SKing]

I have done some work for this organization: AIHA - What We Do

They seem to have goals, similar to yours. You can contact them for help with the letter and fundraising. They have a lot of experience.

Thank you so much!

SHALENA

 

[cacobaka]

Hello,

I think what you are planning is wonderful and needed. You may be interested in checking out this link. They are an organization in Haiti which I really admire called Heartline Haiti. They have a maternity center, and meet with pregnant woman once a week giving classes and medical check ups. They then have a maternity hospital where the woman can have a dignified birthing experience. Their website can be found here: Heartline Ministries - Haiti There is also a blog for one of the midwife's who is a missionary for them, and can be found here: www.livesayshaiti.blogspot.com

I also think that on top of providing the services- education, education, education! For example, I know many Dominican woman who for a number of reasons have a belief that bottle feeding is better. Formula is expensive, they are poor, and because of it they make a much less powder to milk ratio to make it last longer.

I hope to see this project flourish and will help if needed

 

[SKing]

Hello,

I think what you are planning is wonderful and needed. You may be interested in checking out this link. They are an organization in Haiti which I really admire called Heartline Haiti. They have a maternity center, and meet with pregnant woman once a week giving classes and medical check ups. They then have a maternity hospital where the woman can have a dignified birthing experience. Their website can be found here: Heartline Ministries - Haiti There is also a blog for one of the midwife's who is a missionary for them, and can be found here: www.livesayshaiti.blogspot.com

I also think that on top of providing the services- education, education, education! For example, I know many Dominican woman who for a number of reasons have a belief that bottle feeding is better. Formula is expensive, they are poor, and because of it they make a much less powder to milk ratio to make it last longer.

I hope to see this project flourish and will help if needed

Thank you for the links. Yes, we will provide much needed education. It is culture that has them to believe things that are not true and some that are even detrimental. What you wrote about the formula is certainly detrimental. Since it is a culture of thinking that we would like to change it will take some time. Studies show that to change a culture of thinking it takes on average 3 years for the effects to be seen. I do not know where the official misinformation is learned, for example who tells these doctors that babies get no nourishment from mom until day 3? Do they learn this in the University? Without stepping on toes we will educate women so that hopefully they can be prepared to educate others and stand up for themselves. We have to give them to tools to stand up to La Suegra when she starts screaming that the baby is crying because mom is not giving it enough food by breastfeeding.
We (especially myself) have a lot of programs that we would like to implement....my prayer is that we get funding to do so.

SHALENA