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.

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: