“Organizing for Change”
Author: Nahreen Ahmed, Chief Resident
Today was a particularly eye opening day as we had the opportunity to meet the manpower behind many of the efforts in Guayamate and the Bateyes. We met Lilo and Eduardo, two very active and motivated young men who are passionate about inciting change in their community. Together with up to 30-40 other volunteers, meaning unpaid individuals who are self-motivated, they comprise the organization named “180 Grados” (180 degrees in English). Most volunteers are older boys and young men, many without education past 5th grade. Nevertheless, they have proven to be a powerful force. Lilo and Eduardo gave us a bit of the history behind the organization, which was initiated by Guillermo, a Spaniard. from Spain. Guillermo was shocked by the conditions in the bateyes when he visited for another reason in 2005, and he started a young man’s group shortly thereafter. Organizing was difficult, and at first there was little to show.
In 2008, 180 Grados had their first organizing success – a vaccination program in the bateyes. This was in response to data that showed that only 9% of the batey population could show proof of age-appropriate vaccination. The accuracy of this number is questionable as many people were given injections that they were not sure were vaccinations or other treatments (e.g. antibiotics). The vaccination program was broad and successful, and this success led to a recognition of 180 Grados power to mobilize many youth for social good.
In 2011, when the Haitian cholera outbreak spread to the Dominican Republic, Guaymate & the bateyes were particularly at risk because of the migrant worker population from Haiti. Leadership from Guaymate Hospital specifically credit 180 Grados with keeping the cholera outbreak controlled through aggressive outreach in the bateyes, including early identification of infected people, rehydration treatment, chlorination of drinking water, and use of hand-washing with soap. The hospital leadership believes the outbreak would have been much worse without 180 Grados.
Most recently, 180 Grados was leading the effort to secure the donation of 2 ambulances from the Japanese government (more on this topic in a later blog).
Eduardo and Lilo shared with us the health barriers that people living in the bateyes face. Two in particular caught my attention:
-How cultural barriers contribute to health disparities and misunderstandings
-Human rights and documentation.
For instance, HIV prevention is difficult to teach as there are cultural perceptions of condoms and their actual effectiveness. Although they are available for use, they are seldom sought out. Most people do not seek medical attention unless they are feeling unwell and so many people may have HIV and are not aware. Due to a variety of reasons (including cost, travel, missing work), most people will only see medical attention for symptoms (e.g. headache, fever, diarrhea). At times these symptoms may underlie a serious illness, but often they can be self-managed. Diseases that are more indolent and chronic, (e.g. hypertension, diabetes, chronic HIV) are often not diagnosed or diagnosed very late in the disease process. Sadly, many die from preventable deaths, and the community wonders why hey may have gone undiagnosed and therefore untreated for years.
Regarding human rights and documentation, recently the Supreme Court of the Dominican Republic restricted the citizenship of many people who have only known the Dominican Republic as their home. Until I came to this country, I was unaware of the history and current political & cultural tensions between the Dominican Republic and Haiti, with many people from Guaymate & the bateyes being caught in the middle because of their mixed or even unknown heritage. Eduardo informed us that if someone is born in Haiti and comes to the DR with documentation, they are eligible to attend school past the 8th grade. However, many do not have this documentation, and they have difficulty going to the capitol of Santo Domingo to confirm their status. On another level, if a person with Haitian-born parents is born in the DR, they are not granted any form of documentation and therefore is not allowed to go to school past the primary level. For someone like Eduardo, who was born in the Dominican Republic, who speaks Spanish primarily, who has never been to Haiti, who knows no other country but this one as his own – the current laws restrict him from advancing his life through education and work.
While the purpose of our trip is in no ways political, and while outside organizations should be hesitant to pass judgement on internal conflicts that we know nothing about, this truly seems problematic to improving the health and well-being of the people in the bateyes. The Dominican government has said it has a plan to recognize the people who are affected by this ruling, but this is a largely unempowered population. The glimmer of hope lies with people like Lilo and Eduardo, who are talented and charismatic leaders driven by their need to make changes in their community.
Eduardo showing us around a bateye (more in a later blog)
One of the ambulances that 180 Grados was able to procure from a Japanese donation