Swinging from fruit trees
San Juan de Dios Hospital | Santa Ana, El Salvador
El amor de atender, el deseo de servir
“ONE was a mango; the other was a guayaba. My brother and I loved to swing high and fast,” she says. “Two big fruit trees, at the house where I grew up. My parents hung a swing from the branches.”
Dr. Dinora de Viana, the first female director of the pediatric department at the public hospital, San Juan de Dios, in Santa Ana, El Salvador, tells the story of when she decided to be a doctor. As she speaks, the heart-shaped chest piece on the stethoscope around her neck, by which many young patients remember her, stands out amid the toys and fading yellow and purple walls of her office.
“Then one day," she continues, "he fell off the swing and cut his knees. I carried him home. I cured him. That was when I first realized I wasn’t afraid of blood. I thought, ‘maybe I’m destined to be a doctor’. I was 12 years old when that happened.”
Dr. Dinora de Viana, the first female director of pediatrics at Hospital San Juan de Dios in Santa Ana, El Salvador, smiles during a conversation in her office.
Twelve…nearly the same age as the oldest patients here in the pediatric wing. But most are newborns, infants, and toddlers: young and vulnerable, with medical issues that no one should have to face in 2017.
A woman with black hair sits in a chair next to a crib holding a 2-year-old boy. She looks 65, could be his grandmother, but she’s his 41-year-old mother. “Héctor’s hair was once dark like hers,” Dr. de Viana says, “but it lost its pigment, turned blonde, and started to fall out, because of malnutrition.”
Blonde with malnutrition, Héctor (2) is with his mother, Jesús Leivas Trigueros (41), from Acajutla, in the open space where Fundación Rafael Meza Ayau is planning to fund a new building for the pediatric wing. Jesús says the hardest thing is being at the hospital alone with her son while her other duties - and her two other children - are neglected.
Dr. de Viana is worried, too, though not surprised. She’s seen a lot of these cases. Many mothers don’t have resources to raise a family. Many are single or teens without family support. They can’t work and take care of their kids at the same time. It’s a vicious cycle of poverty.
Héctor is severely underweight; he's lucky the doctors saw him before his organs failed. After weeks of living in a chair next to his crib, Héctor’s mother learns he is finally healthy enough to go home.
When she speaks of her experience, the deep lines on her face grow even deeper as tears begin to flow. “It’s hard to be here alone with my son while my other two kids are at home; my 12-year-old is looking after my 5-year-old,” she says. “There’s no father. He drank and drank and hit me; I left. Now I’m single. I worry they’ll take my kids away; there’s no one else if something happens.”
Such hardship appears in stark contrast to the bright colors, the warmth of nurses’ bedside manner, and the hustle and bustle of the children's wing. If a child gets sick, many mothers have to spend money they can’t afford: to eat, for medicine, and for a bus between the hospital and home. If they miss work, they lose pay and maybe even their jobs.
Such hardship appears in stark contrast to the bright colors, the warmth of nurses’ bedside manner, and the hustle and bustle of the children's wing.
“At least we have some beds here,” the doctor says, so some moms can avoid paying for a place to stay. Fundación Rafael Meza Ayau, which has supported the hospital since it was founded in 1928, built an "albergue" - the newest addition to the wing - where mothers of premature and malnourished patients have beds and showers they can use during their stay at the hospital.
But without enough beds for all the mothers of all the patients - there are over a hundred at a given time - most sleep in plastic chairs jammed next to their kids. The hospital hopes a new building will fix this problem.
“Our hospital is poor, too," the doctor says. "We lack space, staff, and equipment.” Fortunately, they have an ally. The Fundación will fund a renovation to address the wing's most pressing issues, to save more lives, and to improve the quality of life for patients and their families.
“My hope is that when I retire, the pediatrics wing will have many floors for all the specialties: general pediatrics, cardiology, neurology; so moms don't have to go so far to get care. This will improve the health of children in this area. That's my great hope and passion," she says.
Dr. Dinora de Viana reviews an x-ray with staff.
Still, the road ahead is a difficult one. With over a million children in the western part of El Salvador, it will be a big challenge to take care of everyone. "To do it," she says, "we must be up-to-date, well-trained, and fully prepared to offer our best technical competency.”
This is why Dr. de Viana stays positive, always arriving with a smile. She has a healthy diet and always exercises before her morning prayers for strength. She sets a positive example for young doctors and nurses, who face long hours and a lack of rest. Rosario España, a nurse at the hospital for 36 years, works up to 2 straight days. And Jimmy Posada, a med student who loves the direct care that pediatrics offers, struggles with his long and demanding 34-hour shifts.
Nurses, doctors and students gather to discuss patient treatments at the El Pabellón de Pediatría del Hospital San Juan de Dios en Santa Ana, El Salvador.
With so many patients who need attention, there are simply not enough doctors or nurses to keep up. And the cramped conditions mean possibly catching something at the hospital. “Imagine coming in for diarrhea only to get pneumonia as a patient,” she says. “Now you must stay longer to get treated for both."
Fundación Rafael Meza Ayau is raising money for a renovation of the pediatric wing, which will mean more space, more staff, and more equipment. “Once this happens, we’ll be able to provide better care to patients. It’s a challenge that we’re happy to take on.”
About this there’s little doubt. The doctor and her staff have dedicated their lives to the boys, girls, and mothers at the pediatric wing of Hospital San Juan de Dios. It’s as if they were all brothers and sisters, swinging high and fast from two great fruit trees, and Dr. de Viana is there to catch them if they fall.
Rosario España (56) has been at Hospital San Juan de Dios for 36 years. She likes pediatrics because of the direct attention she can give to patients during shifts of up to 2 days. “I want to give my heart to everyone."
Dr. de Viana talks to her staff during her morning visit to patients.
Pediatric Department at Hospital San Juan de Dios.
A patient from the pediatric wing has a tender moment with his mother.
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