When we began starting our community health needs assessment for the Clínica de Familia in La Romana, we noticed an interesting trend almost immediately in the answers we were receiving to one particular question. When people were asked what were there greatest concerns about their health, an enormous percentage of people (22% or some 44 people) commented that their greatest health concern was the economy. For these people living with much less access to quality healthcare, it was very evident to them that health was associated with wealth. And the levels of poverty in the Island Hispañola are ever evident to the world, especially since the earthquake in Haiti in 2010.
And that's another interesting point: the Dominican Republic is often compared and perhaps shadowed by its neighbor Haiti, which unfortunately has the highest burden of HIV in Latin America and thus the Western Hemisphere (some 120,000 inhabitants of Haiti are currently living with HIV). In comparison, the Dominican Republic is considered largely "middle class" and less individuals living with HIV (around 60,000). However, the divisions of wealth still vary greatly in the DR, and the burden of disease is still quite large even in the shadow of Haiti. In urban areas, 60% of urban dwellers are classified as living in the middle to superior quintiles of poverty, that is, the majority of urban dwellers belong to the middle class or higher. Contrastingly, 43% of those living in rural communities belong to the lowest quintile (CESDEM, 2008). However, the reality is that a large portion of the poorest in the Dominican Republic are Haitian, making the issue even more complex. Furthermore, reading these statistics are much more striking to me now, especially after seeing the faces of the 43%.
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| Fields of Sugar Cane courtesy of James Marvel |
The day was overcast and the six of us traveled with Luís - our volunteer coordinator and Elizabeth - a woman from the Clínica de Familia that works specifically with vertical transmission. Three of us sat in the back of the pickup while passing by the endless miles of sugar cane fields. The blades of cane shot up in various degrees, their sharp fingers stretching upward tearing at the heavens, perhaps in hope that they might just open up. Often, we would pass workers on the side of the road carrying machetes, covered in the eternal remnants of the cane. We turn down one small road. Shacks began appearing, and soon a letrero appeared before us, its faded letters barely legible: "Batey 82".
The truck came to a slow stop next to a set of buildings – presumably houses. The spilt, uneven grey wood sandwiched between concrete floors and tin roofs marked the age of the incondite building. We hopped out of the truck and headed towards a group of individuals. Their skin was dark like midnight and their thick French-influenced accents hinted at their Haitian roots. One Haitian woman holding a small infant greeted Elizabeth with a kiss and warm embrace. Elizabeth wrapped her arms around the toddler and gave him kisses on the head. Eventually, Elizabeth handed the baby to Luís and we headed up the steps to the gray house.
I glanced around, taking in the surroundings: a man with a hoe was walking towards the house slowly on the dirt road; a woman behind the house was shoveling coal into a bucket in a small shack, the grey polvo covering the radiant dark skin of the woman; another five-year-old child sat on the porch next to us, timidly examining us. I noticed a small caldera filled with coals where food was prepared and cooked. Food was scarce for this family, plagued potentially by the lack of access to education and even further plagued by the threat of HIV. (And despite these impoverished conditions, it is not uncommon to see individuals in the bateyes or in poverty with a cell phone, principally prepaid and incredibly cheap.)
The conversation between Elizabeth and the young Haitian mother did not last long. Nonetheless, it was clear that this Haitian woman depended on Elizabeth's constant visits and even more her constant love. We prepared to leave, the visit all too short but filled with compassion, glazed with humility and gently sprinkled with humanity.
As I smiled at the infant and he began to smile back, I realized that, despite the extreme boundaries that separate the wealthy from the poor and all of the factors that predispose a person to a life of poverty, sickness, and extreme disadvantage, there still are some factors that transcend the boundaries of sickness and health like that of a simple smile.
