Health Care in the D.R.

Presentation at a rural clinic on dental care

An essential part of serving as a Peace Corps Volunteer is living with and like the locals. This means cooking with local foods (Examples: yucca, plantains,and auyama), taking part in community events (Examples: church celebrations, dominoes, and chair sitting), and getting used to not having certain amenities (Examples: running water, 24/7 electricity, and Krispy Creme). However, there are other aspects of life which Peace Corps Volunteers will never be able to truly integrate, such as how we take care of our health.

The disparity in the quality of health care I receive versus my neighbors has made me uncomfortable a times. As a volunteer I have access to three doctors, one of whom is always on-call, as well as free medicine and treatment. I never have to worry about the cost of a procedure, if I need it Peace Corps will pay. I probably have the best health care plan of my life right now. My neighbors are at the other end of the spectrum.

Preventive health care is essentially non-existant in my rural community. I do not know of anyone who goes to the doctor and dentist for yearly check-ups. There are no school nurses or yearly eye exams for students. It all costs too much. Aside from brushing ones teeth and eating a balanced diet not much else is done until someone gets sick (And many people do not brush their teeth and eat healthy).

When someone gets sick the first thing people do is wait to see if it gets worse. Have a toothache? Wait until you can't eat. It costs three times as much to get a filling as it does to get a tooth pulled (A cleaning can cost even more). Vision problems? Stand close to the chalkboard. I don't know of any kids of the 300+ I have worked with who wear glasses. When the Chikungunya virus was spreading around the country like crazy, no one went to see the doctor until the pain from their joints made it difficult for them to walk, and even then most of my neighbors didn't see a doctor. Again, seeing a doctor is expensive. Just going to and from town can be expensive for many Dominicans.

Probably in part because of the inaccessibility of doctors, most medicine can be bought without a doctor's prescription (including Prosaic and Viagra - the latter I have seen handed out to men at a bar in the capital). However, rural Dominicans often prefer local plant remedies. Tea made from the leaves of a cotton tree are said to be great for anemics. Alcohol is often also used as a substitute for pain medicine. It is not uncommon for teenage girls with menstrual cramps to take a couple swigs of Mama Juana, a rum-wine-plant root beverage.

When an illness or injury does become very serious Dominicans will go to the hospital, but the results are not always the best. As I mentioned a few weeks ago, sometimes the doctor needed will not be at the hospital and patients end up waiting hours to receive treatment. Once a patient has been admitted to the hospital they typically have to share a room with six to eight other individuals. There are no special wards for different types of injuries just one for men and another for women and children. There are better hospitals located in the capital - you know someone is really sick when they are sent to the capital.

Side note about babies: Due to the unavailability of doctors when it is time to give birth Dominicans with some money prefer to schedule caesarians instead of giving birth naturally, to ensure the doctor will be present for the entire birth. Also, many women go home with their babies the same day they are born, via motorcycles. There are not enough beds for women to stay more than one day, and there are no laws here saying you need a car-seat before you can leave the hospital. Would it even be possible to make one for a motorcycle?)

A lot of improvements are needed in the Dominican health care system. Thankfully, things are slowly headed in the right direction. All medical centers offer free HIV/AIDs testing, and many offer free birth control. This year many hospitals, including the two major hospitals on the Samaná peninsula, are being expanded and remodeled to provide more services and treat more patients. Also this year a national 9-1-1 system was launched. As its next step I would like to see the government begin to provide more health care services at schools. Ensuring kids know how to take care of their personal health from a young age will go a long way to ensuring healthy generations to come.

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Library Update: The library now has a cement floor! We plan to install the floor tiles and paint over the next two weeks. Tentative inauguration date for the end of November. - It is time to start planning the celebration party!

Now it's time to make it look pretty!

Dominican Music

You will never be asked to turn down your music in the Dominican Republic. Why? Because blasting your music is part of being Dominican. How did blasting music at all hours of the day become socially acceptable? I have no idea, but I am thankful that I never have to worry about offending anyone when I throw dance parties with the neighborhood kids. The downside is that I am sometimes woken up by a neighbor's stereo system at 6 a.m. (when the power comes on).

For an entire month I was woken up by this song:

It was a rough month.

Thankfully, the above song is not representative of Dominican music. Indeed, the above song is from a Venezuelan singer popular in the late 80's. Much more often you will hear bachata, merengue, salsa, or dembow music. All of which I am come to enjoy. Here is a break down on what they all sound like:

Bachata
Bachata was created in the D.R. in the early part of the 20th century. It was once considered to be the music of country-folk - the lyrics and dancing were considered too vulgar for the wealthy, but today it is the most common music you will hear on the radio. The are a multitude of great Dominican artists in this genre. To get a good mix I recommend the "I love Bachata" album series which is available on iTunes. (I have 2013 and 2014.) The most well known singers of this music are Prince Royce and Romeo Santos, both of whom are Americans. I prefer Romeo Santos - his album Fórmula Vol. 2 is amazing and features mainstream American artists: Drake and Niki Minaj, although their Spanish singing skills are wanting.

Decide who you prefer by listening to two of their most popular songs.

First Prince Royce with "Darte un Beso" (Give you a Kiss):

And now Romeo Santos with "Eres Mía" (You are Mine):

Merengue:
Merengue, like bachata, is native to the D.R. Created in the 19th century the music was made popular by the country's dictator, Rafel Trujillo. Merengue is now one of the most popular genres of music in all of Latin America. Merengue music tends to have a faster beat than bachata and the dance is also more rapid and features more spins and turns than bachata. I think meregue is more fun to dance, but only if your dance partner know what they are doing - otherwise you are just dancing in a circle.

There are not many female singers heard on Dominican radio, but Miriam Cruz is one exception. Check her out below with the old but classic "La Loba" (The She-Wolf):

Salsa:
Salsa originates from Cuba, and is not nearly as common as bachata or merengue. Bachata and merengue can be difficult to distinguish at first, but since salsa was developed off the island its sound is unique. But if you can't hear the difference, you can always tell when a salsa is playing because only two couples will be dancing. Most Dominicans do not know how to dance salsa - they seem to like to stick to their native dances: bachata and merengue. However, there are still well known Dominican salsa singers and most Dominicans can sing along to salsa songs played on the radio. Here is Yiyo Sarante with "Pirata de Amor" (Pirate of Love):

Dembow
Dembow is a new and evolving genre, original to the D.R. It is a form of rap stemming from Puerto Rico's reguetón music (think "Gasolina" by Daddy Yankee), however now it is its own beast. I use the word beast because dembow lyrics tend to focus on sex, drinking, and generally acting wild. Dancing to dembow is similar to dancing to American rap music - just find a stranger and start grinding up on them. Get your booty shakin' to this next song by El Alfa, "Subete en el Caballo" (Get on the Horse). And yes, the title is a sexual innuendo.

Just for fun, below, is a more innocent dembow song. This song is about the Chikungunya virus, which I finally got (and recovered from) last month. I didn't get the severe joint pain as portrayed in the video but I did get swollen joints, fever, rash, and random waves of exhaustion (I fell asleep at my kitchen table surrounded by unopened grocery bags one afternoon.). Still, I consider myself lucky. Many of my neighbors and fellow volunteers continue to suffer from joint pain months after their initial diagnosis. K2 and his song "La Chikungunya" should give you an idea of what they are still going through:

American Pop
Like nearly every where in the world, you can hear American pop occasionally in D.R. The U.S. is close enough that some volunteers tune into Radio Disney to get their pop music fix. Most Dominicans to not know what the lyrics to American songs mean - but that doesn't stop them from singing along.

Slowly Dominican music is making its way back to the States. Prince Royce and Romeo Santos can already be heard on the radio in America - especially their songs that mix English and Spanish and/or feature popular English singers. An explosion in popularity for Dominican music in the U.S. is coming. Are you ready?!

Living through an Epidemic

Imagine a mysterious disease is sweeping through your community. In the span of a few weeks almost all your neighbors, family, and friends have fallen ill. Your government says the disease is a virus from Africa and Asia transmitted via mosquitoes. Would you trust the government's word?  If you live in the U.S. your answer is probably, "Sure, I trust the government and the Center for Disease Control to tell me the truth." Dominicans are not so trusting.

CDC Warning for Vacationers

Right now the Dominican Republic is dealing with an outbreak of the Chikungunya virus (pronunciation: \chik-en-gun-ye). Symptoms include high fever, myalgia, skin rash, and joint pain. Most symptoms go away after three days. Except for joint pain, which can last up to four months. Thankfully Chikungunya is not fatal. Since the virus arrived in the Caribbean in December 2013 it has been spreading like wildfire. Almost everyone I know in my community has had the virus. Some have even claimed to have had Chikungunya twice, although according to medical professionals once infected, a person should be immune for the rest of their life. But Dominicans do not believe this is true.

Dominicans do not believe most of what the government and medical professionals are saying about Chikungunya. Most Dominicans say that the virus has spread too rapidly for it to be transmitted by mosquitoes. Dominicans are accustomed to dengue, another the mosquito transmitted virus. Dengue has similar symptoms to Chikungunya except you can get it up to 5 times, and it can be deadly. Dengue has been present in the D.R. for a long time, so the transmission rate is not as high as it is for the newly introduced Chikungunya.

When asked how Chikungunya is spread, Dominicans will say by the air. The reason why it is spread via the air, however, varies by community. Other volunteers have told me rumors of government experiments gone wrong, a strong wind from Africa, and a chemical spill. In Samaná, the region where I live, the theory is that the cause of the virus stems from toxic trash that was dumped along the southern coast of the peninsula. Apparently when the trash was dumped, over 12 years ago, the people in the surrounding communities began to get sick. The government then buried the trash in a different part of the region, and people there began to get sick too, so the government dug a bigger hole. According to my neighbors Chikungunya is just another chapter in the saga of the toxic trash.

All the rumors have made me wonder, "Why don't Dominicans trust the word of their government?" My neighbors say it is because the government is always lying to them. Unlike Americans, Dominicans have not grown up for generations in a country known for democracy and freedom of the press. Many Dominicans still remember what it was like to live under the harsh rule of the dictator Trujillo. Many of Tujillo's successors were not much better. As a result, Dominicans today are suspicious of politicians and the government, and they worry about backsliding into their autocratic past. Chikungunya is a foreign word, it sounds made-up to Dominicans. In a country where previous governments have covered up assassinations and embezzlement, it isn't too far a stretch to think that the government just made-up Chikungunya to hide another problem.

It also doesn't help that even politicians don't believe that Chikungunya is spread by mosquitoes. When Senator Prim Pujals came to visit my community last month he announced that the government was sending workers out to the rural areas to spray insecticide to kill mosquitoes. He then said, "Not that it matters much, because Chikungunya is in the air."

One thing everyone can agree on is that Chikungunya is not done its rampage just yet. It is expected that by the end of the summer 50 percent of the population on the island will have become infected. I have yet to become ill, but my time may be out shortly. I will soon be spending five nights at a summer camp with over 100 other girls from around the country. It should be a fun, if exhausting, time. The camp is at an eco-lodge so we will be outside all day long, and it just so happens that the mosquito that carries the virus is a day eater (or so medical professionals would have us believe). A good number of volunteers and kids were struck-down during the boys camp a few weeks ago. I am bringing two girls from my community who luckily have already been infected so they are safe. However, I am not. Wish me the best of luck!

So as not to end on a ominous note, here are some awesome things that happened this week:

A portion of my neighbors' generosity

• It rained a lot so now all my tanks are filled and I got to wash my laundry.
• Kids came to class in the rain!
• I have teenagers helping out with my literacy classes.
• My neighbors gave me 6 mangos, 4 bananas, 6 plantains, 20 passion fruits, and too many limoncillos to count!
• I made 5.2 liters of passion fruit juice. I gave half of what I made to my neighbors (different neighbors than the ones who originally gave me the fruit).
• Power was out in my community for 42 hours, that is a new record since I have been here. The awesome part is that it came back on!
• Romeo played with another dog - Romeo has "issues" and doesn't really like to hang out with other dogs. He isn't aggressive, he just doesn't like to interact with other dogs.
• Kelly and I played Monopoly with my 9 and 14 year-old neighbors. Kelly and I where called tramposas (cheaters) - it was a blast. More to come about competitive cross-cultural differences next week.

  

  Monopoly Negotiations