A normal day in the NICU at Hospital Arco Iris is quite a contrast to the average American NICU experience. This 16-bed unit is by far one of crowning stars of the hospital and a well-respected center for care of sick newborns in all of La Paz. It is managed exceptionally well under the leadership of Dr. Bedrigal, the Pediatric Chief of Staff. What distinguishes this unit is that, on a given shift, it is run by a team of one licensed nurse (the equivalent of our registered nurse) and one auxiliary nurse (with similar responsibilities as that of our Licensed Practical Nurse). These two care for the entire patient load, including three newborns on ventilators. There is not a respiratory therapist on staff so whenever the physicians are not present, any intubating is done by the staff nurse.
Anna Maria, the NICU charge nurse, does an exceptional job at managing this challenge. She works with this overwhelming case load with calm confidence and unquestionable competence. Her compassionate and comprehensive care of each newborn has earned her the admiration and respect of the doctors and hospital staff. Each newborn brings a set of individual challenges. A recent baby was born with an audible heart murmur. The condition was undetected in utero due to lack of prenatal care. The challenge after birth was finding a pediatric cardiologist, and the country of Bolivia has three pediatric cardiologists. One was suffering from a medical condition at the time, one was in Africa and the third one was unable to be located by the staff.
So, neonatal care goes on, wrestling with the limitations while striving to provide excellent care.