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.

machetes, motos and caña

Today, I witnessed a fight in the streets of Pancho Mateo. One woman apparently slept with another woman’s hombre, and this conflict quickly escalated. When I poked my head out of the church where we were doing research, I spotted the larger of the two women wildly swinging around a machete. The skinner woman retaliated by literally stoning the woman and then left on a motorcycle. The two community members I was talking with, who were seventeen and eighteen, said that these kind of fights are common.

I played a game of pick-up soccer on the community’s basketball court. I kicked some butt with a pass that turned into an assist that turned into a goal, so I totally scored a goal by just two degrees of separation. Our goalie was a little boy, who was no more than seven or eight years old.

The children on the court were all eating sugar cane. It’s easy to get to since the sugar refinery in the nearby town of Montellano closed down five years ago. The cane is free and readily available if you just cross the highway and hack away with a machete. I still haven’t gotten used to the idea of elementary school-age children handling sharp and dangerous tools, but here they were.

These same community members offered us sugar cane. The texture is like cardboard. You bite off a hunk and chew, thereby sucking out the sugar inside, and spit out the stalk once you’re done with it. There are pieces of eaten cane all around the basketball courts because these children chew so much of this stuff. It’s also incredibly calorie-rich, if incredibly lacking in all nutritional value.

Then one of the research participants handed me the machete and the cane. Holding the sugar cane in my left hand and the machete in my right, I hacked away. One little boy ran away when I started to swing the blade and understandably so. But I didn’t chop my fingers off and everyone left with the same number of limbs that they started with, so I’m going to call this one a victory.

I met a man in the Dominican Air Force (and I know this because he was also dressed in full uniform) who offered to give me Spanish lessons and liked me because there is a WWE wrestler who shares my name. A nine-year old boy was fighting for my attention and definitively declared that I was his gringa girlfriend. I chatted with a twenty-nine year old with a seven year old daughter, absolutely amazing dreadlocks and massive biceps. I danced with a little girl, listening to music that someone was blasting from their cell phone.

So in a lot of ways, Pancho Mateo is nothing like anything I have ever experienced. The community is full of cultural norms that I find jarring. But those differences, although important, do not matter in a lot of ways. I was still able to connect with many people in many different ways even though I come from a different culture and speak a different language. Although I was in this community last year, I feel that my experience in Pancho this time around has been more intimate. I’m learning a lot, and my Spanish is going from nonexistent to simply terrible. Yes, this community needs a lot of help. But ultimately, it a community of people living and working and playing together, and that sense of togetherness and that welcoming nature is invaluable and deserves to be recognized.

first reflections from the dr

I’m alive, and I’m well. Well, sort of well. My wisdom teeth are fine, but the stitches are starting to come out of my gums. (It’s pretty attractive.) It’s like I have two mosquito bites in the inside of my mouth. I’m also coming down with a head cold, probably due to a combination of the pollution and the stress of traveling and not sleeping in my own bed and the chain smokers in the hotel that we’re staying at. Breathing is becoming way more of a challenge than it should be.

But those, when all things are said and done, are minor complaints. As I’ve mentioned numerous times before, I’m here with Health Horizons International (HHI). This is my second trip to the DR, and I’m working in the same community that I worked in last year called Pancho Mateo. Last January, our group from Tufts conducted a comprehensive health survey and found that the major public health issues identified by the community were related to sanitation and access to uncontaminated water. It’s been amazing to go back to Pancho and see the same buildings and the same people. What’s even better is being welcomed into the community once again.

One familiar face belongs to a community health worker for HHI, and our group really connected with him last year. He’s our age (and he’s so totally my Facebook friend). When we walked into Pancho for the first time on Sunday, he was so excited to talk about the project that he and his buddies started working on in November. They formed a working group to address those same community-identified needs that we uncovered in January, most specifically in regards with water. They have started drafting letters to the government and to private contractors in order to install the proper plumbing and to fix water pressure. The ultimate goal is to ensure that everyone in their community can easily access and use clean, safe water.

tufts hhi

As I've mentioned before, I'm going to the Dominican Republic with Health Horizons International. We leave on Saturday, and I'm getting so excited to get my international travel started. As part of our group's project, we've decided to start our own blog: Tufts Health Horizons International. I'll be writing for it, as will the rest of the members of the group. If you want to keep tabs on the specifics of our public health project while we're down there, please visit that page. I'll be blogging here about my own personal experience.

It's surreal that this trip is so soon. I feel like I've been planning this week since I left the country last year. I'm excited to return to the community that I visited last year, and I cannot wait to learn about a new community this year.

But I still need to pack...