September 15, 2013
Author: Amy Huang, UIC Med-Peds physician
As our trip is coming to its end, I am struggling to get a good handle on my thoughts and emotions. While we’ve had a really busy 10 days in Guaymate, it’s actually quite difficult to explain to people back home what we’ve done and what we hope to accomplish. Even some of my good friends and family members are puzzled when I tell them I didn’t need to pack my stethoscope with me for the trip.
In short, we are utilizing peacecare’s Global Community Health Collaborative (GCHC) model to initiate a grassroots intervention to improve health services and/or build capacity to existing health systems as peacecare has done through its other projects in Senegal and Ethiopia. The first phase of the GCHC is partnership formation, which was the main goal of our first site visit to Guaymate in March 2013. During that trip, Lillian, Nate, and I met community leaders and learned about their health systems and infrastructures. With Peace Corps Volunteer Rosa as our liaison, we quickly integrated into the community and were able to get everyone excited about a long-term partnership between Guaymate and peacecare. Over the next few months, we started the second phase of the model: community assessment, which culminated into focus group discussions conducted by the Guaymate Community Advisory Board (CAB) members to find out specific concerns of their health and health services. Our main objective for this trip was to conclude the assessment phase and to begin thinking about potential interventions to carry out during future site visits. To do so, we had to meet with the various stakeholders to discuss possible collaborative efforts and obstacles.
And what complexities we have learned through each meeting! Guaymate is a municipal located in the province of La Romana. The 30+ bateyes surrounds the town of Guaymate are part of the municipal. Focus groups and key informant interview reliably identify a major problem: lack of health promoters to provide basic health services in the bateyes, which overwhelms the municipal Guaymate Hospital with urgent and nonurgent visits, leading to inconsistent care provided by the hospital. Added to the problem is that the caneros (sugar cane cutters) are Haitian. They have extended families living with them in the bateyes – it is not uncommon for a couple to have 8 to 12 children – who do not have documentation that is recognized by the Dominican government. The Guaymate Hospital, being a public hospital, sees all patients who walk through its doors. However, when a patient is undocumented, they are not counted in the official hospital records, meaning the hospital does not get financial reimbursement for treating undocumented patients. We met with the director of the Guaymate Hospital, Dr. Oscar Estevez, a few days ago. He shared this frustration with us, stating that his staff is often overwhelmed and overworked, and the hospital is scarce in resources. In fact, when we visited the hospital on Friday, the place was dark and the laboratory paralyzed as their generator is broken so the hospital had no electricity. To make matters worse, Guaymate being a rural town suffers very much from brain drain. The hospital has no full time staff. The ER is staffed by contracted general practitioners who are waiting to start their residency training. Specialists, all of whom live in the bigger city of La Romana come see patients in the “consulta” in the morning before quickly rushing to their private practice clinics in the afternoon.
The bateyes are private properties of Central Romana, the sugar company that owns most of the land in La Romana and is the major employer of both Dominican and Haitian resident of Guaymate. One of the problems Central Romana shared with us is the movement of the batey residents. Caneros often come and go; return to Haiti for a few months before coming back or moving to a different batey, making it difficult for them to do infection control. The Haitian migrant workers also have inherent different health/cultural practices that may rely on homeopathic treatments before seeking medical attention at the hospital, sometimes at the price of their lives as they present too late to be treated. The division between Dominicans and Haitians, which we felt immediately during our first visit to the DR, is ever-present as the Dominican physicians struggle to communicate and sympathize with their Haitian patients.
So where does this leave us? Underneath these layers of complexities, power-struggles, and politics is still this vibrant community that is eager for improvement. While we are not bringing our stethoscopes or medical supplies to provide patient care, we bring a sense of commitment and compassion, to learn and grow together with the community, and to give them a sense of empowerment. As the GCHC model as taught me, you’ll find answers if you put the community in the center; let them tell us what they need and what they want. Lilo, one of the CAB leaders, summarized it perfectly during our last meeting: “We (the CAB members and youth volunteers) live here. We are the eyes and ears of the community, and we can bring medical issues to your attention. With peacecare’s help, we can make a difference together.”
Back in Santo Domingo, as I sit in the Spanish Plaza enjoying dinner in the Zona Colonial, I couldn’t help but think of my friends in Guaymate. I wonder if the electricity has come back for the night, or are people just sitting out on the streets, chatting with their neighbors, waiting for “la luz” (the lights) to return so they can wash their dishes, bathe, and get on with their nightly routine.