Diana Rosa Hernández Acosta always liked working with children, so when she graduated from Nursing in 1995 and was placed in the Neonatology service, it did not cross her mind to go somewhere else.
“I had already done an assistantship during my degree, and although it was not in my plans to work there once I graduated, they placed me in the service and since I liked it, I stayed. I have been with newborns for 28 years, including the time of the two missions that were also in Neonatology services, first in Botswana (2001-2004) and then Qatar (2016-2019).”
This is how this woman refers to speaking slowly and softly, perhaps due to her habit of, as a rule, not raising her voice so as not to disturb the little ones who are under her care.
With a degree in Nursing, a specialist in Maternal and Child Nursing and a master’s degree in Comprehensive Child Care, she assures that hers “is a difficult job, but at the same time the most tender and fascinating there can be. And as time goes by and the more you know, the more you fall in love with him, because there is no case like it and for many other reasons.”
Why, despite years of experience, is it still a difficult job for you?
“Because you have a life in your hands; I generally work with critically ill patients, in whom a mistake, no matter how minor, can have consequences and cost them their life.
“We work with ventilated children, preterm children of less than 30 weeks, who when they are intubated the tube is 2.5 cm, with a super small lumen, any secretion can obstruct it and cause an asphyxia event.
“Then you have to prepare and plan well all the care that is going to be given to the newborn so that there are no complications or errors and you have to study. Those who are teachers study all the time, and the more you know, the more you realize that you don’t know and how much you still have to learn.
“A month ago we had a meeting with the head of the Ibero-American Society of Neonatology, Dr. Augusto Soca and he has that same perception, that the more you know the less you know and it is true. Whenever we have the need to learn more, the better we will work, fewer mistakes will be made, more children will be saved, there will be more children with a better quality of life, with fewer consequences and more happy parents.”
How is work organized in the Neonatology service?
“I generally only work with one or two patients, because they are usually critical cases. Neonatology has two intensive therapies in which serious and critical children are cared for; an intermediate therapy that cares for children who are recovering from that state; and two fattening cubicles, because there are low-weight ones that are fine, but they need to have a certain weight to go out into the room; The second fattening cubicle cares for full-term children, children with jaundice who are treated with phototherapy (light treatment) and maternal causes, which are those whose mothers are seriously ill in the Intensive Care Unit and the little ones must be cared for because the family At that time he cannot take charge.
“We stay next to that patient all the time, no matter how exhausting it may be, we always gain strength.”
And is it the clinic that tells you how the patient is?
“Speaking professionally, we know the condition of a patient from the clinic, yes, but we say that it is also the eye, because in a child who is well the color is pink, he is active, for us who are used to working with them, we know look at him if he has the face of a satisfied child, a happy child.
“He who is sick moves little, his color changes; Generally, when a septic process is starting, it acquires an icteric coloration (we say dirty, icteric-green), there is distal, perioral cyanosis, livedo reticularis (vasomotor alteration in the skin of the extremities, more rarely of the trunk, caused by persistent vasoconstriction and irregular distribution of arterioles); He does not tolerate food, if he is breastfed he rejects it and so they give you signs. Sometimes they cause fever, other times they don’t, or they cause hypothermia; A child who does not regulate temperature, there is something wrong.
“The monitors also help us… if it is pericardial, there may be a lack of fluid, it may be a septic process, because fever is also accompanied by tachycardia; If a child is ventilated, the saturation on the monitor is a parameter that guides us a lot.”
You insist that this is a team effort…
“The patient I am working with is assigned a specialist. That specialist visits you, makes the instructions and we indicate and apply all the care.
“The specialists stay in the room for a long time, when they leave, the guards come in and ask us how the diuresis is going, if it is saturating well, if there are many secretions. In this way, we communicate, we apply all the care and they receive information about how the child is doing, in addition to the fact that they can also detect and realize situations that are happening.
“We have a very great strength in the figure of Dr. Reinaldo Menéndez, director of the maternal block, who has administrative knowledge and the Maternal and Child Care Program (PAMI), who has known how to lead the team of obstetricians to have satisfactory results and to apply the science, the research in what they do.
“We are a team, which is why the results of the low infant mortality rate in the province are due, because we receive the product of the work of obstetrics and Primary Health Care. And if we have good results it is because everyone is doing their best.”
How rigorous is the training in this specialty?
“There is a specialty called Pediatric and Neonatology Nursing, of which I am the coordinator and I care for the residents of the Neonatology Nursing specialty. The medical residents are cared for by medical specialists, but we are not divorced, the doctors give Nursing lectures and topics, participate in their exams, in visiting visits.
“The function is to teach them how to care for a newborn, a critical neonate, and give parents tools so they can do quality work.
“Students and new entrants take a long time to stay alone in intensive therapy, and when they spend around five or six years working in therapy with someone with more experience at their side, they move on to those positions.”
Today they work in a new Neonatology room
“The room is beautiful, we have been in it for about two months. The climate is perfect, it has excellent conditions, even a pantry with a microwave to heat lunch, with water that cannot be missing.
“The people in the department have a sense of belonging and everyone cares. If there was a department that had not reached the deterioration of other wards, it was the Neonatology service. Repairs began due to leak problems, but the room, in general, was well maintained.
“We have a team of assistants and it has a lot to do with the administration, there is an established system of how to clean the department, how many times to clean, how it should be done in each area, what the assistants can touch. and what is up to us to disinfect; What has to do with the patient is cleaned and disinfected by the nurse; “What has to do with the floors and walls is the auxiliary.”
There is an entire program at the national level from Primary Care to help the mother reach a happy term in the best situation.
“Everything is very well designed so that mothers arrive in optimal conditions to have their child, but sometimes some things fail. There is also a strategy to provide guidance to women at gestational risk, at risk due to distance, to admit them to maternal homes, to give them the guidance they need, so that they can reach term successfully and do not arrive underweight.
“That’s something that works. But there are always those who do not fulfill their individual responsibility and that is the case that we later have there.
“We have always had a priority, we are not exempt from deficiencies, but we have not felt the situation of the country in terms of resources in Neonatology because we are guaranteed medicines and supplies.
“We have had shortages in recent times with aspiration tubes, with feeding tubes, with some other medication, but attention to the department is prioritized and we have the basics for patient care and saving their lives.”
Diana, many people, in the current context, have left the sector, What is your opinion on this matter?
“What makes people leave is not the job
