Common Themes

Currently I am in the Dominican Republic, part of a 12-person medical service trip whose aim is to provide care to marginalized communities in Santo Domingo.  We have just finished 4 days of work in Paraiso, just north and west of town, and are taking a day to rest and reorganize prior to shifting our worksite to Los Mina, a neighborhood that merges into a shantytown hugging the banks of one of the city’s rivers.

When here, a few different things always strike me.  One is the fact that underserved communities face similar obstacles to care all around the world.  There are differences in degree and in quality, but common themes visible anywhere people lack necessary care:

--Inadequate medical workforce: healthcare systems are most efficient and have the best outcomes when primary care is a strong component of the system.  In inner city and rural America, as in Paraiso or Los Mina, primary care is notably absent and patients lack access to efficient and available primary care services.

--Importance of community determinants of health: whether it relates to unsafe neighborhoods in the US that keep our families and children from exercising and being physically active, the absence of sources for healthy foods (too many fast food restaurants and not enough fresh veggies and fruits), or a lack of potable drinking water and prevalence of parasitic stomach infections, individual health is heavily dependent on the broader community’s obstacles and resources.

--Improper healthcare interventions: in the US we tend to have an over-reliance on high tech interventions, whether medications or advanced testing and imaging studies—even if these interventions do not actually improve health.  In Paraiso, many patients seek care in more expensive private health care facilities and are prescribed expensive or unaffordable tests and medications.  In each case, the cost to the individual and (if insured) to the system is very great even though the actual outcomes are no better for the investment.  Alternative options—focusing on preventive care, wellness, and health maintenance would stand to provide a better return on investment but do not have the necessary influence or awareness to change general practice patterns.

--Those who are powerless lack influence: a self-evident statement, but one that needs to be noted.  Many of those living in Paraiso and Los Mina are squatters, lack title to their land, and are largely disconnected from the political system.  Similarly, minority and poor communities in the US (that make up the majority of our underserved communities) lack political heft and influence.  Without this influence, communities are hard-pressed to effect change on their own behalf.  Community-identified leaders (whether the official government leadership structure or influential community members) can work to organize the community to try and effect change, but to make change sustainable is very difficult when individuals are just barely making ends meet.  By partnering with communities in ways that identify and support their own resources and by providing assistance in ways that empower the community without imposing an outside agenda, it would appear to be possible to start creating structures that can have meaningful and sustainable results.

I suspect more commonalities will become evident as I reflect more on this trip.  I know that many of the experiences I have had and skills I have learned in rural and urban underserved communities stateside stand true in the Dominican Republic, and vice versa.  I hope that by my direct action, and by teaching students and working with communities, that a greater good can be advanced.