Them That's Got Shall Get

*This one is a bit darker than most of my entries, it’s longer, perhaps a little drier as well, and definitely preachy. I tried my best to de-preach but it was just too hard. So read on, only if you’ve got a strong stomach.

I got the gripe (which I will describe later) a few days ago. The first day it really manifested itself was also the day of a tour of the hospital for the region where we are currently training. We met with 2 former Peace Corps volunteers who now work for an NGO down here called Infante Sano. It’s partnered with some Bostonian business men and the Harvard Children’s Medical Center. They were inspiring, and really motivated me to get working in the Dominican health system. But what really struck me that day, and is something I will likely remember for the rest of my life, was the tour of the facility.

Earlier in this portion of training we asked women about their pregnancies: if they saw a doctor pre or post delivery, where they gave birth, etc. At the time I was pleased that all women that I interviewed reported going to the hospital we toured, or to hospitals in the capital, as opposed to delivering at home or in a rural clinic. After seeing the hospital though, I’m less sure that they were better off there. We didn’t actually get a look inside the delivery room, but I was told there are just a few beds, with no sheets, and at the time we were there, 5 women were giving birth on one bed (perhaps they had found some sheets for that one bed) with no doctor in sight. It is not possible to have your husband or boyfriend or family member in the delivery room with you, so those women were pretty much all alone. I found this out from an American, who I was told was a Harvard grad studying medicine at the hospital, who looked panicked as she was running down the hall looking for help. She explained briefly to our guides what was happening.
I’d heard that in this part of the world nurses are scarce, so family members attend to the sick when they go to the hospital. That was the case. Most rooms had old beds with thin mattresses, only some had bed nets, and no rooms had AC. We saw people of all ages, all sharing one thing in common; they looked like they were in agony. The children’s ward was especially challenging to see, as I’m sure you can guess. One nice thing was that the women from Infante Sano had some local artists come in and paint some murals a while back, so at least the walls looked happy.

We got to see the ER. It was like nothing I’d ever seen before. It was a room not much bigger than a walk in closet with a closed, locked door that needs to be banged on to be opened. Two patients were being attended to when we walked in. One was an old man who looked tired, but like he was being taken care of. The other was a young boy who I believe was being stitched up on his face. I saw the string, and the needle, but could not see exactly where they were going. I didn’t think the doctors or nurses were using any painkillers because he was trashing around on the bed quite a bit.

If any of this has stricken a chord within you, I hope it doesn’t make you want to write a check. The problems that this country is facing are so deep, and so difficult, and unfortunately the answers won’t be as easy as writing a check. A check will only last so long, and then the people who used it will wonder how they’re going to get the next one.

One very fundamental issue to try to understand is the way the political system works. The Dominican presidential election is coming up. There’s the incumbent, Leonel Fernandez, who was also president a few years ago, and his main opponent Miguel Vargas; both of these men have wonderful smiles, which are plastered all over the country. And then there’s Amable Aristy, who doesn’t seem to stand much of a chance. My understanding is that he is conservative, but our definitions of what is conservative and what is liberal don’t quite translate here, as I’m sure you can imagine. (Fernandez is said to be the more liberal of the two main contenders.) Aristy’s campaign is active, and I see more commercials for him than the others; he claims to be the president for the poor. Here’s where the problem comes in, his commercials, legitimately, consist of poor Dominicans attesting to his character because he gave them free stuff, like money to start a workshop, a house, a job, medications, etc. Then they say” I know he is the man for the job because of the favor he did for me.” The gifts seem to have been given out quite arbitrarily, as in someone wrote him a letter asking for a bicycle so that they could get to work, and he decided to help them out. While that is all fine and good, it’s no basis for being the head of state. And this example is not the exception. The other political parties do it too.
There’s some sort of understanding that a good political official is someone that gives handouts, including jobs. The problem then becomes what is going to happen when that elected official’s term is up. For example, President X believes that the healthcare system is in need of help, and decides to go for a national healthcare plan and appoint all of his friends to high ranking positions within the ministry of health, including the heads of hospitals, and before the plan is fully implemented, President Y comes in. Even if President Y wants the plan to move forward, he is going to remove all of President X’s men and women from their positions and put in his new people. You can see where this is going. (This is, in fact, something that President Fernandez has been working on, but of course it is slow going.)

Here are some real life examples on a local level. I’m living with our technical trainer and 3 other volunteers in a little community which has a very active community group. One of the members is the mayor. The other night at a meeting, the leadership of the community group was discussing how much they could benefit from having a group truck or bus. Everyone turned to the mayor and he agreed to buy one, with political or government funds, for the group. The following day, they took us on a smashing tour, during which we all had a lovely time. I wasn’t so much surprised that school children and working parents were able to come with us on a Friday morning (there was a teacher strike, again, so school was out, again, and people don’t tend to work in the same way we Americans imagine, ie: the money just arrives though no one really goes anywhere), rather I was surprised that the group was able to borrow the bus, pay a driver, and then take us all out to lunch. But I should have known better, they mayor paid for that too.

I’m not trying to say that handouts aren’t good, they are probably very much necessary in many places in this country. What I am saying is that they aren’t sustainable, which is crucial, as us Peace Corps trainees have been talking about since we got here, and that it might be better if the government realized it too. I shouldn’t pretend to be some expert on this subject, and very willingly acknowledge that I am just visiting and don’t know much about development, much less the Dominican Republic. It just seems as though instead of the government, or more specifically the president, doing personal favors in select areas of the country for select communities, it might be more productive in the long run for things with more lasting results (such as national scholarship programs, teaching colleges, nursing schools, free accessible, universities, perks for engineers, doctors, and other well trained professionals to stay in the country, and others) to be initiated and not only dealt to friends of the political party. It makes no sense to me why there would be free, accessible water, a public clinic, and paved roads in some small rural communities and not in others. People, Americans and Dominicans alike, who have been here a while, or all their lives, have told me that the communities with the nice stuff are the communities that have been selected by the president to receive it, likely because of their political support. But no national plans to bring all rural clinics up to some standard, or pave all roads, for example, are on the table.

So we don’t want you to write a check to fix the public health system in the DR. We would rather encourage getting involved in something sustainable, like contributing to small business loans, or coming down to visit me, or someone else, or even stepping out from the warmth of a security blanket and going to train people in what it is that you know, even if it’s just a group slightly less well off than you and it’s a cooking class, or yoga. Unfortunately my time here isn’t even sustainable, which is why I have to work tirelessly over the 2 years to ensure that someone within the community will take over the various roles I will fill when I leave. It’s going to be difficult, but I’m excited to try.

Perhaps some of you with more regular access to internet could look up what the experts are saying about this issue generally, and then also with regard to the DR. I’d love to read some insights from people much smarter than me. Try posting them here if you find anything of note.