backlog: Batey hopping.

My work in the DR is structured in a rather circuitous way – as both a program evaluation and a needs analysis concerning access and utilization of health services – making things kind of hectic, much like many endeavors in my life. It’s been a long running start, building up to a rapid finish.

Following weeks of reviewing literature, struggling through meetings (en español, por su puesto) with stakeholders, and participating observantly, the madness of surveys began. I developed a rather extensive, 100-question, quantitative-data collection instrument and trained two Haitian medical students (able to translate Spanish into Creole when needed) in collection methods. After testing and revising the survey, we collected information from multiple field sites in individual Batey communities.

As a background I ought to explain that the organizations with which I’m working provide healthcare through mobile ambulances to communities without access to any other types of health services. This includes preventative medicine, treatment, prenatal care, health-education, and so on. Accordingly, there are huge varieties of unmet needs. At the same time, these Batey communities live on the fringe of society and suffer in need of many other types of services, like education and sanitation infrastructure.

In the name of ethics I won’t reveal too much about the project here or now, but I will say that it has been challenging to segue between the areas of inquiry and practice – between the acts of research versus organizational assessment. The dependency of patients upon these health services limits the accuracy of the reach of a general evaluation survey – these patients lack the typical “rights” of choice, access, and time that other users are afforded in routinized healthcare services. At the same time, as a development and public health practitioner, it’s hard for me to adapt my motivations to fit solely within the “curiosity” realm of the researcher who seeks definitive “conclusions.” Neither my professors nor supervisors were able to guide my thinking in order to pigeon hole the work in one way or the other and I suppose it isn’t necessary.

For the mean time, I’m considering the most appropriate categorization of this project (which will likely inform the thesis I will begin preparing next month) as a practice of applied research to make things work better and more efficiently while meeting the basic needs of individuals who deserve and need critical health services.

balancing act

Subsequent visits to the Bateyes have been less shocking and more as per my expectations. The Mobile Health Clinics enter the community bright and early, encounter a long line of patients waiting to see the doctor, there’s an intake/documentation system, the patient is seen, referrals written, repeat.

It’s not exactly fun to see the pregnant teens who’ve not had any pre-natal care and are in their 6th month. It’s painful to see people’s faces when they realize that the prescription they’ve just been given is in fact not available from the mobile clinic and that procuring such drugs will mean a long, long walk into the capital to spend money on drugs that are unaffordable. It’s terrible when at 3:00, after 8 hours and 40 patients have been served and the one doctor is ready to leave, a family of four show up wanting to been seen, yet are told they’re too late and need to wait until the next visit, two months later.

In comparison, it’s so easy to forget all this misery as soon as one leaves the Bateyes and returns to the Capital. It feels light years away. I’m guilty of forgetting too, given how much more comfortable it is to work here in comparison to other field assignments I’ve had the privilege of working on. Given that I’m enjoying my time spent here in which I’m NOT Working, and how permitted and encouraged this enjoyment is, it’s difficult to stay focused on the numbing inequalities and social injustices, when I’m not standing in the middle of them. What I really mean is that the comforts of the ex-pat lifestyle here - with friends, modern public transportation, lux beaches, and wi-fi – are keeping me significantly distracted from the misery and circumstances then I’ve ever been within a developing country.

And this blog has suffered for it accordingly. Evidently, it’s only when I feel able to compare things here with things somewhere else that I feel able to write something interesting. As I head into the field with surveys to implement and photos to take, I’m promising myself to stay more connected to the realities on the ground. Vamos a ver.

p.s. Is anyone even reading this?

backlog - June 20 - Gaga in the Bateyes

It took me all of half a second to understand that “agárrate” meant “hold on” when the random man with a motorcycle took off, heading against traffic, on a 6 lane highway. I guess he decided to help me as I was wearing a black dress and running late to my first meeting with the executive director of MOSCTHA. The wind in my un-helmeted hair was a welcome rush after the cab, which a police officer put me in, dropped me off in the middle of no where, following a 15 minute walk in the wrong direction, after exiting the subway at the incorrect stop. A good start to this first meeting as the ED, el Doctor, kept me waiting for 45 minutes insisting that I, “la jovencita,” drink orange juice.

The work may not be as exhilarating as the moto-ride, but it’s becoming interesting and I’m finally getting my feet wet. Literally. Who knew that a trip to a batey meant traipsing through mud and cow paddies to get to the latrine?

Picture this disparity: a five minute drive off the perfectly paved road, lined with mini-malls and car dealerships, lie crop-fields after field only punctuated by trickling rivers and the shrillness of Dominican kids laughing. Houses with tin roofs, rotting wood walls, and a burnt out edifice or two are all that constitute the neighborhood. Perhaps a brightly painted “Palé” sign indicates that one can buy lottery tickets, and a small “colmado” – the ubiquitous Dominican general corner store-cum-bar - sells warm soda, sugar, eggs and toilet paper in the center of town. Kids run about with muddy toes and snotty faces, some lucky to have shoes, but most not. Old men sit and watch the road as if it were television, and mid-twenty year olds are unanimously missing from the scene. My first visit to Yaco, one of the Batey communities that MOSCTHA works with, felt so similar to an east African village, I almost felt the culture shock that I never seemed to experience there, because there, the reality was merely the manifestation of long-standing expectations of mine. That was Africa; this is 600 miles from home.

I stayed surprised when they kids were first shocked by my whiteness, but then adoringly curious – patting my skin and hair, fascinated by the camera and babies wide-eyed and frightened – and was completely caught off guard upon realizing that the Gaga performance that we went to visit could have been rolled out directly from TASO’s cultural performers.

Little did I know that the Gaga, originating from the Haitian ‘rara’ music and dance street festival stylings, is in fact derived from a celebration of African ancestry of the “Afro-Haïtian masses.” Wikipedia informed me that Vodou is often part of the processesion which serves to unite communities across cultural divides and bring people together (details which were unfortunately lost in translation from Kreyòl, to Spanish to English. Regardless, it was really a fun introduction to a Batey and hopefully you’ll find it interesting and curious as well. Check the video and photos below, more photos here.

June 9 – Movers and Shakers, the Health System and a visit to San Juan

I turned on the television for the first time today and was a bit taken aback when shots of the Brooklyn Museum were the first images to pop onto the screen. I shouldn’t have been: it’s not easy to miss the connections between NY and the DR. Though, in a country of approximately 10 million people (a country boasting the biggest economy in the Caribbean and its leading tourist destination), it’s still wild to realize that the diaspora of approximately 1 million Dominicans is mostly concentrated in the City I left.

Nearly everyone here has family there. The people talk in the streets about Washington Heights! I’m clearly learning a lot about things I never anticipated: the DR is the largest exporter of immigrants to the City, with (evidently) 10% of the public school system servicing Dominican-Yorkers who are the second largest Latino population of NY; according to historian Jesse Hoffnung-Garskof (read his very interesting series of Q&A’s on the DR and NY here ) the musical culture of Merengue was “intensely shaped” by NY’s rock and disco eras; and, perhaps more interestingly, the powers of racial politics, in terms of resisting a black and white divide (though not so much in terms of racism and discrimination against Haitians) between the full-color-spectrum population here, has manifested in NY in a similar way, in that the sheer number of Afro-Caribbean populations within the five boroughs enables rather homogeneous enclaves where such distinctions are not necessarily required.

I’ve also been surprised to learn just how historic this place is. The first site of permanent European settlement in the Americas (in part by the French in Haiti, the other half by the Spaniards), the island of Hispaniola is dotted with colonial reminders: handfuls of cobblestone, narrow streets, copious churches and cathedrals, and familiar sounding names like Bolivar and Ramirez. Independence from the Spanish was followed by a Haitian take over, then by a US occupation (between 1916 -24), and subsequently by a military dictatorship, before bringing about the current democracy (If you’re interested in more history or details of this place, wiki can tell you about the pre-Colombian days of the indigenous Taíno peoples).

The Ruins of the San Francisco Monastery - the oldest Monastery in the Americas

This all said, there are big schism-like divides here. This country abuts Haiti – only 560 miles away from my home state of Florida and the poorest country in the hemisphere - in which everything appears to be abysmally worse (details on the Haitian/Dominican relationship when my summer research solidifies further). And while you can travel by Mercedes, use high-speed wireless internet, and drop $600 a night at an all-inclusive resort, this place is still teeming with poverty and underdevelopment.

During this past week, the complexities of this country have become more forthright. As guests of the Ministry of Health, Vivian, Margaret, Kate and I travel to San Juan de la Maguana, the capital of the province of San Juan near the Haitian border, to visit their system of public-health care delivery in rural communities. As for contradictions and calamities – it was good, really good, for me to get out and see some legitimate social and economic need to mentally locate this country as a “developing” one – it was very curious to travel as guests of the state (more or less) and visit the proclaimed best-resourced and best-run public health clinics in the country.

Only two years old, the system is a network (o “red” en español), of small health clinics that serve individual communities and refer patients in need of follow up or laboratory services to the appropriate venues. While this sounds rather basic and logical, the majority of persons with health issues here still go directly to the Emergency Room or Hospital, creating a terribly over-burdened system that doesn’t function properly.

One of the primary health centers, a doctor, and an epidemiological mapping shot:

A visit to the Hospital was rather unnerving at points, as we witnessed bloody footprints on the ground, abandoned corridors, and extremely malnourished children. However, on the whole, the place functions remarkably well and seems to run fine: