DR - Month 2

This month has been really good for me in terms of work. I finally feel settled in at work which is great, and I have been given more and more responsibility which I am really enjoying. My IRB was finally submitted, and I am being given a lot of programmatic responsibility in terms of the batey program, they are actually having me write a whole new program plan which is exciting. I go out to the bateyes three times a week and the rest of the time work out of the clinic in La Romana. I also went home for the first time this month which was great. I saw my fiance and we went out to eat at one of the Dominican restaurants in Washington Heights and I talked to the waitress in Spanish, so it’s fun to know that when I move back I will be able to continue my cultural exchange J I am making more attempts to integrate more into the Dominican culture which I didn’t do a very good job at last month, especially due to the language barrier. But I am learning more Spanish, albeit slowly since I don’t use it very often, which has been good and I am making some Dominican friends.
But culture – it’s been hard. My last month was basically about culture, but I will elaborate here. Basically, I am trying to improve the health of a population which the system is against. The levels of racism exist from individuals all the way up to government levels, and are extremely apparent. They are bought and sold like slaves between sugar cane companies, and they are denied access to most public systems (which while not great, are at least something!). Calling someone a Haitian in this country is one of the biggest insults that there is. Anyway – this is a part of the culture that I find ugly, and I have been trying very hard to separate this aspect from some of the other aspects of the culture.
This month there was a Haitian man who came into our testing program in the bateyes who was being carried by his nephew because he was too sick to stand up. He tested positive so I brought him to La Romana and checked him into the emergency room. He was admitted that night and his nephew stayed with him. The next day his nephew said he had to leave and I told him he needed to send a caregiver but he didn’t, so I ended up visiting the man a few times a day to bathe him change his clothes and wash his sheets (he could stand on his own, so it wasn’t pretty) and to make sure his IV had been changed. More often than not it had not been. The nurses kept telling me they would do his exams but didn’t and if his room wasn’t clean they would ignore him when they went to do their rounds. Finally I just put him in a wheelchair and took him to do his chest x-ray for TB, and when it came out negative they told me they would start him on ARV’s. Almost a week went by and he was never started on medications and I was finally told that he was going to die. Well, his nephew still hadn’t come back or sent anyone. I had spent a significant amount of time with this man at this point, so I called his nephew again to let him know that his uncle was going to die. He told me to just leave the body he didn’t want anything to do with him. He told me that the hospital could and would throw out the body. I was appalled by the way he dismissed him so I pressured him a bit until finally he admitted that he wasn’t the man’s nephew. The man had no family, so this guy took advantage of the situation thinking/knowing that he would die, and he had just wanted the funeral money so he could feed his family. He never had any intention of helping his “uncle”. I went to the clinic and talked to them about the situation and we all agreed to keep him at the hospital until he passed away and then I could take care of the funeral in La Romana. The man died less than 48 hours later, and myself and one the social workers at the hospital worked out the funeral arrangements and buried him later that day. I know that I probably should not have been involved to that point but I didn’t see any other options at any point along the way, and I sleep soundly knowing that he was buried properly and is finally at peace.

My first month

I got engaged on the Saturday, the 30th of May, and left for the DR on the 1st of June! Needless to say, I was a bit antsy and overwhelmed when I got here, but things have settled a bit, and I am really enjoying my time here (and this photo is of my backyard, which is lovely). Missing Ben is no fun, but we have been talking every day, and I can't wait to get back to the US and start planning out wedding! I did pretty much everything I could to ensure that people were expecting me and they still didn’t seem quite sure what to do with me initially. However, things have been clarified and I have been doing a lot. My first study is going to be a qualitative analysis of why people are/aren’t coming in for HIV treatment once they have been tested positive. I am working with the batey (sugarcane field) project here, so I go to the bateyes three times a week, and the other days, I have been working on IRB application stuff and going on home visits with the palliative care team here. I am also going to maybe be doing a needs assessment for a local hospital and then also doing quantitative research on the migration patterns of batey residents and their levels of HIV knowledge, attitudes and behavior. I have learned a lot of Spanish, but it’s not going as fast as I would like since I work mostly in Kreyol (and English). The place I am staying is outside of the city a bit, and there are lots of Americans around, so it’s hard to get practice in. The other students from Columbia got here on Monday of this week, and as much as I love having them around, I am going to have to be really careful not to get sucked in to gringo land!

Being here has been relatively shocking, and I don’t think I am shocked by much…I knew there was tension between Haitians and Dominicans, I just didn’t realize how high the tensions actually were. I talked to a woman one of the first days I was here up in Puerta Plata who told me that they had found a Dominican man strangled in his house, so in turn, Haitians were being slaughtered with machetes. I have no idea who “they” is, but she told me that they were planning on killing 300 Haitians for the one Dominican man, because that’s what his life was worth. They had killed two by the time I talked to her. Who knows what pieces of that are reliable, but still. I also have been doing a lot of hospital visits and such, and the way they treat Haitians/people with AIDS (and if you are both, you are totally screwed) is just horrifying.
Then last Friday I went to the hospital with one of the Haitian home visitors from the clinic to see a Haitian patient we had gone to see the Tuesday before. That Tuesday, he had been at a different hospital, but the Doctor sent him home because he said everything was fine. The guy could barely sit up on his own, and his body had been totally destroyed by AIDS. Apparently, this doctor has a reputation for sending patients home before running the appropriate tests (especially patients who are Haitian, or with HIV).The social worker, hearing that he had been sent home, went up to the batey (sugarcane fields outside the city which are staffed by Haitian migrants -- that's where I'm working) to bring him back to the city and took him to a different hospital to get a TB test. So Friday we went to visit him and they hadn't yet done the test at the hospital, so Elizabeth took the sample herself and took it to the lab on her own (mind you, she doesn't work for the hospital). At this point Elifer can barely open his eyes and can't move on his own. So while we are waiting to make sure the nurses come in and change his IV, he has a seizure. It was probably the most horrifying thing I have ever seen. I honestly thought I was watching him die. His mother fainted, then woke up and started screaming, and meanwhile, the nurses did nothing. I left with the mother so they could take care of him (her falling on the floor, me trying to get her somewhere to lie down) and when we came back they hadn't even touched him. Not even to wipe the foam from his mouth. He was ok at that point, and fell asleep after that, but Elizabeth and I left to go call a family member to come stay with his mother and by the time Elizabeth got to the hospital, they had left. They didn't trust that he was going to be taken care of so they went home (how they got there, I have no idea). He passed away at home last week and we went to the mass for his funeral to support his family. He left behind 7 living kids (two have already passed away), one girlfriend (his wife passed away last November), his mother (who has no other children in the country) and two grandchildren. I have never worked in HIV before, so just seeing the web of people affected by this disease is very difficult. I don't yet know what is normal here, I am just going off of what people say, so it’s still hard to judge what aspects of the care are due to discrimination or just normal care in the DR, etc...
The children are also raised to not like Haitians, so the kids who were born here (even if they have Haitian parents) don’t identify with the culture at all, and most of them don’t want to speak kreyol. I was driving the other day with a Haitian woman and one of the kids who was washing windows/begging in the street yelled at her that she was a dirty Haitian even though the kid was very obviously Haitian himself and was begging in the street. I am trying to figure out how I am going to develop a program that works within this system.

I am working on expanding my experience here to extend to Dominicans so that I can get the other side of the story of what is going on here. I really love being out in the bateyes, and the Dominicans that I have met so far are really nice. I am adjusting pretty well and I am going back to NY in July for a few days to celebrate my engagement and see my family, and I will also meet with the office in New York about all of my IRB proposals that are being put together.

That's about it from here, I love and miss you all, give Ben hugs and kisses for me, and I will see everyone soon!