thoughts on public health in the dr

I got back from the Dominican Republic on Saturday evening, and I still haven't been able to fully process my week there. What has struck me about the experience is the lack of control that these community members have over their own living situation. Above is a photograph I took of the sugar refinery in Montellano, which is within walking distance from Pancho Mateo. For years, the sugar company controlled nearly everything in Pancho Mateo. It was the main source of employment for the community members. It built the barracks around which Pancho Mateo sprung up. It literally shaped the landscape of the community. The sugarcane refinery is still visible from the distance, and the otherwise fertile ground across the street from Pancho Mateo is blanketed by sugarcane.

Since the whole sugar industry was such an important force in this community's existence, it only makes sense that community members would hold onto the hope that this force would re-emerge. There are constantly rumors flying about that the sugarcane refinery will re-open, despite the absolute dearth of evidence to prove this. But talk is important in Pancho, and when those in power aren't communicating with the community, gossip can be just as authoritative as law.

The sugar company isn't the only mysterious outside force ruling over Pancho Mateo. A slew of small apartment buildings - which are shown on the right - sprung up in last February. They were apparently contracted by the government, but no one with any authority has come to talk to the community to tell them who will move in or when. We talked with one man from Pancho Mateo who even helped to build these apartments who doesn't know anything about them. Common knowledge says that these buildings were built in order to buy votes for the upcoming Presidential election, but there is no strong evidence of that either. These buildings are now standing on the side of the highway, completely empty, and no one in the community can know for sure why the government built them in the first place. From what we were told, there is no real desire to find the answers to these questions, but even if there was, the contact person in the government is unknown.

This lack of follow-up from outside organizations - be they private, governmental or non-profit - is clearly a major problem in Pancho Mateo, so I understand why an organization would not want to take on a project without knowing that it can follow the intervention through to the logical conclusion. This community has already been toyed with extensively, and there is no reason to continue that tradition. Although talking and qualitative research may not have as tangible an impact as some kind of infrastructural intervention, it still affects the participants and it still can raise hopes. In my opinion, I believe that it is equally negligent to go into the community and to ignore then what community members have to say.

If we want to help this community, we need to take the information we have gathered from the community and use that data in the residents' best interests. If we know the community's primary concerns, we should act on this. And if we do not listen and respond to the community's concerns, we are ultimately no better than the sugar company or the government in its negligence and thoughtlessness.