Our partner communities are rural villages in the mountainous inland, as well as bateyes surrounding the defunct Montellano sugarcane refinery. Bateyes are communities that were constructed by Dominican sugarcane companies in the early 1900s to house Haitian migrant workers and their families. Now, the bateyes on the north coast have expanded beyond the original barracks into full communities, and are home to poor Dominicans and Haitians alike.
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The communities we serve face multiple challenges: lack of access to quality medical care, a dearth of public health services such as potable water and public sanitation, institutionalized discrimination against the Haitian minority, and a changing health profile that is increasing the burden of chronic disease borne by the poor. Many individuals suffer from untreated chronic illnesses because they cannot afford transportation to a doctor, whose capacity may already be limited by an overburdened health system. The cost of medication is prohibitive, due partly to soaring unemployment. Intestinal parasites caused by lack of access to clean water, and infectious diseases that could be prevented through public health interventions, are far too common. A lack of proper nutrition, safe places to exercise, and community investment in health education, are all barriers to healthy lifestyles.
Unemployment is purported to be nearly 80%, due in large part to the closure of the sugarcane refinery in 2005, combined with the recent global economic downturn and its resultant effects on tourism. Access to health care is limited by economic, geographic, and socio-cultural barriers. Access to education is similarly limited, although efforts by NGOs and the Dominican government have made important steps in improving primary school level education. Hunger, lack of adequate housing, and lack of access to clean water are also widespread issues. As in the country as a whole, it is important to note that disparities in living conditions, economic opportunities, and social determinants of health exist between Dominicans and Haitians (as well as individuals of Haitian descent born in the DR), due to structural, historical, and political factors.
The surrounding area includes a Dominican middle-class, ex-patriots, and tourists. There are many non-profit organizations, both Dominican and international, working in areas like health, education, microfinance, and evangelism. While the government is often criticized for corruption and inefficiency, structures and systems to regulate health care, education, social security, and more, do indeed exist. However, populations marginalized by poverty, racism, and social inequality are often excluded, in theory and in practice, from fully enjoying the benefits of such systems.
Arroyo de Leche
Three rivers, boulder-ridden mountain roads, and an hour-long motorcycle ride separate Arroyo de Leche from the nearest health care facility. Many households are able to grow staples like yucca, plantains, and beans to feed their own families, but large-scale agriculture is no longer a viable source of income. Some residents work tending cattle for large owners, but unemployment affects the vast majority of families. The community’s geographic isolation, the expense of transportation, and the lack of economic opportunity are all major barriers to consistent primary health care for Arroyo de Leche’s 200 residents. High blood pressure and diabetes are growing concerns, especially considering the difficulty of consistent access to medication.
With only 85 Dominican and Haitian residents, Negro Melo is the smallest community that HHI serves. Before the Montellano sugarcane refinery closed in 2005, nearly all residents worked as cane cutters, in the refinery itself, or in the local economy that arose around the sugarcane industry. The population of Negro Melo’s batey section (barrack-style housing built around the Dominican Republic in the early 1900s to house Haitian migrant workers) has since dwindled significantly as residents have moved closer to town in search of work. However, religious leadership, local government, and family ties contribute to a strong sense of community among residents. Due to its high rates of unemployment and geographic distance from health care facilities, many of Negro Melo’s residents do not have access to basic medical services. Hunger further contributes to many residents’ poor health.
The largest community in which HHI works, Pancho Mateo is home to nearly 2,000 Haitian and Dominican residents. Since the closing of Montellano’s sugarcane refinery, Pancho Mateo has been deeply affected by unemployment, hunger, and poverty. Many Haitian immigrants and their children remain undocumented, presenting a formidable barrier to employment, education, and medical care. Overcrowding, a dearth of latrines, and a lack of public sanitation in the community’s large batey section contribute to the spread of infectious disease, while lack of access to potable water leads to high rates of parasitic infections. Racial tensions and socioeconomic disparities are more apparent in Pancho Mateo than in more rural communities, given its history and population. Uncontrolled high blood pressure and diabetes are increasingly significant health concerns.
A rural community of approximately 300 residents, Severet is composed of two batey sections amid a spread-out Dominican village. Similarly to Negro Melo, the community as a whole faces high levels of unemployment and hunger, especially since the closing of Montellano’s sugarcane refinery. Severet has an active religious community and strong local government which support community development and education initiatives. However, Severet’s distance from health care facilities and level of poverty present important barriers for families in accessing medical care. Intestinal parasites affect a significant portion of residents, highlighting the lack of clean drinking water.