Naranjito

I spent the last week on a medical mission up in the mountains outside Santiago, translating for American doctors and dentists.  It was a good experience, and I was surprised at how much I was able to say—I didn’t know much medical terminology, but neither did the patients. The group comes three times a year to the community, and over about 13 years, has constructed three clinics, a church, and a school house.

I helped a dentist pull a tooth, and sucked up blood with the sucker hose.  The tooth broke off, and he had to really dig in there and cut open the gums to get the rest out.  After that, I didn’t assist with any more tooth extractions… I stuck to translating. I was paired with a doctor in the women’s clinic, and did a lot of pap smear and breast exam translating, which was quite an experience.  In my down time, I did patient intake, taking blood pressure, temperature, weight, and height measurements, and patient history. 

Peace Corps has a med mission group, but this was not a part of it. I’m actually still trying to figure out how I feel about this group. They didn’t pay for PC volunteer travel, and the volunteers they brought had to pay quite a bit in program fees.  The clinic runs three times a year for 3.5 days, and they keep files on all the patients they see, but there is no health education or follow ups.  People are given drugs with no real explanation of the side effects, and for things like diabetes, no one explained the need for sustained dietary change.  They should have required a class or group or something for every patient who had high blood pressure, taught by locals, and sustained between clinic visits—use community members who frequent the clinic as health education workers. The director was also pretty direct about asking for donations, which put a bad taste in my mouth. I also don’t want to hear the phrase “we just touched so many lives this week” ever again.  Talk about a circlejerk.

Poverty tourism. Well-meaning people paying to sleep under mosquito nets, eat beans and rice, “help the poor” for a few days, and take cold bucket baths to wash off the white guilt; then, back to the posh hotel, and back to the States, without ever leaving the group or holding a peso. 

13 years is a long time to have a presence somewhere. A few of the Americans had known local kids since they were born, and really seemed to have a connection to the place, but would never come visit on their own—they wouldn’t know how to get there.  We all stayed with host families in small tight compounds of caneboard kitchens, bedrooms, and outhouses, and while not posh, they were comfortable; like most things in the DR, they were arranged to different material aesthetics and functions than Western standards, but that doesn’t mean that they are inferior (or that the people who built them are inferior). I guess that’s what I’m trying to say with a lot of this—walking through a campo like Naranjito with a lump of acidic repulsion-guilt in your throat doesn’t show you anything other than your own views. You “see” part of the island that doesn’t look like an all-inclusive resort, but if that’s a solitary event that doesn’t affect you any longer than the good feelings after visiting Disney World, and it’s main change is only in your dinner party anecdotes, then the only result of your stepping off the airplane was to add a few pounds of human waste to the Dominican sewers and rivers.

We think of poverty as an economic benchmark, which dictates living standards, education levels, and culture. Poor people are different than us. If they weren’t poor, they would live like us, go to school like us, and be like us. We have, they don’t have. We visit, and give advice, give medications, give dentures, give bottles of shampoo from the hotel, give clothes, give hugs, give buildings. These are all good things, but giving is never sufficient, and in this culture, free is wanted but not valued. With health care, there is so much more to do than simply giving. You have a whole community that values the clinic, but which has nothing really to do with the clinic. If foreign donations dry up, so does the stream of visiting Americans. 

The clinic does serve a purpose, and does a lot of good. A lot of teeth were pulled, a lot of pain was alleviated, and routine checkups no doubt improved the general health of the community. I am being pretty damn harsh on the operation. Maybe the visitors can come and go, and don’t have to experience the place, and can give whatever they want to.  It’s just… haven’t we learned alternative ways of implementing community health programs by now? I think about these things a lot, what with being a foreigner living here and trying to save the world.

There were a few Dominicans working at the clinic, and they were or had become important people in the community. In 15 minutes, I was trained to take vital signs.  Is that something a local couldn’t be trained to do, and to continue doing as a health education worker?  But then, what would the tourists do?