The Home Stretch

19 04 2011

So since my last post I have spent a weekend at a beautiful beach, worked overtime at the clinic, spent a night in the hospital (as the patient), finished with my classes and final exams, and celebrated at least four birthdays. While the events have been exciting, I want to use this post to share some of my observations.

I was reading Juliana’s blog the other day and I realized how incredibly different our experiences have been yet when we talk, we always come to similar conclusions. The pictures alone are enough to realize the extreme difference. She is exploring Moroccan cities, historic European landmarks and taking a mosaics class while I am beach hopping, finding all of the waterfalls possible and taking blood pressure and sugar levels at the clinic. So how is it that we both seem to discover similar concepts when our time has been spend doing completely separate things? To answer this question I will present some of the conclusions we have made and when I get home we can talk about the observations that led to these conclusions :).

1. The American education system is based on analysis and exploration in order to discover more information while other education systems (JJ and I can only speak for Italy and the Dominican Republic) are based on memorizing and regurgitating information.

2. “Study abroad” is a culture within the culture you are exploring. This can be a positive and negative thing.

3. You haven’t really studied abroad if you have spent less than 3 months in the country, and to be frank, you can only learn the superficial and can’t really learn anything substantial about the culture, the country, the people, the language in under 3 months.

4. Being a tourist, or traveling to other countries, after studying abroad will feel like cheating.

5. Americans stick out, in some superficial ways in terms of appearance but also in some deeper culturally rooted aspects.

6. You can’t plan for everything, and while it’s a wonderful skill to have to be able to plan it’s sometimes an even better skill to be able to adapt to change and adjust quickly and effectively.

7. You can learn some of the most profound things in the simplest settings.

8. The resources and opportunities that exist in the United States are valuable beyond measure and I would argue that they are sometimes under-appreciated by Americans.

9. Culture is hard to define. Culture, as a word, is hard to define.

10. If you invest in your experiences even experiences that may seem like failures are huge successes.

My work in the clinic and community has been going so well, I’m incredibly happy and I will be sad to leave. My most recent project was helping one of the doctors with her thesis project. I was able to do some serious data collection and statistical analysis. And she caught on fast that I was good with graphics and the computer so I ended up helping her compose a 100 and some slide presentation. (Oh, I also made a video of photos, complete with accompanying music). My other work in the clinic has included, well, everything. I have been in charge of distributing medication, sitting in on consults so that I can follow up with the patients in the community, making house visits to check blood pressure of hypertensive patients and blood sugar levels of diabetic patients, weighing and collecting patient medical history, giving charlas (informal talks) about various health issues in the community and even reorganizing the medical chart filing system. I have learned a lot about the way in which the health system works from my research and how it really works from my time working. I have seen and I (think) I understand (but never really will) what poverty means. And I have really become in the idea of health system organization in terms of funding structures and allocation of resources. I have observed how the university education system impacts the medical services and what “community” really implies.

It would be unfair to publish a post without at least one picture with water and bathing suits, so here is a group picture from our trip to Las Terrenas in Samana. This was taken in front of a beautiful waterfall called Salto de Limon.

Salto de Limon

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I just want some salad in a bag

1 04 2011

Last night I got one hour of sleep…but Shakira was totally worth it. I went to see Shakira perform in the capital, and Pitbull and El Secreto were opening acts. It was incredible. I have been to more concerts here (3) than I have been to in my 20 years (total before January: 1, thanks to Thomas). When I returned home from the concert I still had to study for an oral exam. The timeline went a bit like this: 1:00pm board bus in Santiago, 4:30pm arrive in the capital, 7:00pm the concert starts (with opening acts), 10:45pm Shakira performs, 1:00am back on bus, 3:30am arrive back in Santiago, 4:00am in my room studying for my exam, 8:00am in class taking the exam. It was all totally worth it.

This past weekend I spent in Punta Cana visiting Alana 🙂 I took the bus all the way there (7 hour trip, it’s literally a diagonal shot south from Santiago to Punta Cana). I stayed in the all-inclusive for 2 nights and it was like being in a totally different world. It felt weird, the whole time I just couldn’t believe that this paradise existed in the country that I have become so familiar with. Everywhere I looked, I just thought, “this can’t be the Dominican Republic”. But I was so glad to have the experience of the all-inclusive and of course over-joyed to see Alana. The pools were beautiful, there was always food and drinks, the beach was just a few yards from my room, there was a casino, sports bar, discoteca, and theatre. I enjoyed my time but I don’t think I could do it for more than a few nights, there is only so much pool, beach, eat, dance repetitions that I can take. And I really can’t stress enough how uncomfortable I felt inside the resort knowing what laid beyond the gates. I made lots of friends with the staff, they were so happy to speak to someone in Spanish and were particularly interested in why I was living in Santiago and what I was doing in the country. If you are ever interested in an all-inclusive experience, Barcelo Premium is definitely the place to go in the Dominican Republic. The pictures don’t lie 😉

I have been craving vegetables. I miss those little steamer bags that you can buy and just eat the raw veggies right out of, or the salads that you can buy with the dressing packets that you put right into the bag and shake it up. I don’t eat nearly enough vegetables here and I think it’s because vegetables in a bag don’t exist. All the veggies here have to be specially washed and while I have a nice large portion of salad everyday for lunch I’m just not consuming nearly the amount of vegetables that I am accustomed to. I also miss being able to walk through campus without getting whistled at, catcalled, or stared down. I just want to blend in again. I considered dying my hair brown but I couldn’t give up the blonde so I resigned myself to sticking it out for another month. I have learned to handle the piropos well; I am just tired of them. I also want to be back in my country where people are conscious of how they dispose of their trash. The streets here are not clean, and while a stable trash collection system doesn’t exist and there aren’t lots of trashcans, the people who throw trash out of their car windows or chuck a gum wrapper on the sidewalk are to blame. The part that is upsetting to me is that I see EVERYONE litter. By everyone, I mean I have seen the richest, the poorest, the youngest and the oldest lack the discipline to put their trash in a trash can. I also miss Yale- I miss my friends, my professors, my classes, the library, the gym, my dorm and residential college, and I even miss the dining hall. I miss being in an environment where everyone is seeking intellectual stimulation. I want to be able to sit with one of my friends in the dining hall or the common room and discuss the most recent episode of House and then talk about the day’s lecture. I want to sit in a library where people are actually quiet and study. I want to talk with a professor who has an advanced degree and passion for his or her area of study. I want to be in an environment that values innovation, not just emphasizes regurgitation. As much as I have enjoyed my time here, I am eager to get home to my country where people abide by the laws on the roads, where people study to further understanding and knowledge bases, and where people can eat vegetables out of a bag.

 





Beach and Health Insurance – what a wonderful combination

23 03 2011

I’M SO SORRY IT’S TAKEN ME THIS LONG TO WRITE A NEW POST! But I have to say, time has suddenly sped up and I am having a hard time wrapping my head around all of the things I have done and still have yet to do in during my time here. Daily life is going well, I feel like a true Santiaguero. I have the concho routes down, know where the best (and cheapest) food is, and probably most importantly I know which stores have frequent sales 😉 Classes are going well, I have gotten to the point with my language that I can zone out for a second and zone back in and not have missed much, in other words I am understanding everything without having to be clenching my jaw and straining my neck muscles in constant attention (not that I’m doing any zoning out in class…). My research is going very well, I have started working in la Zona Sur with a health promoter and I am finally all knowledgeable about the health systems here and will be starting interviews next week! More to come on the research later on in this post.

First, let me tell you about the BEACH. I skyped in to one of my sorority’s chapter meetings the other night and one of my sorority sisters said “Gabriella, just so you know it was snowing outside of my window while I was looking at your pictures on the beach. I was not happy.” I have come to realize how much I really do enjoy warm weather. I never really disliked the snow/winter but I have noticed that I do not miss it at all. So I have been taking advantage of my current residence on a Caribbean island and have been to the beach at least once per week. I think I’ve got just about all of the beaches under my belt with the exception of Punta Cana which I will be visiting this coming weekend to see Alana who will be here for her spring break!

My host father’s sister, so my aunt, has a BEAUTIFUL apartment in Sosua- a town in the providence of Puerto Plata which is about an hour and a half from Santiago. She invited the family for a weekend. I can’t even describe how excited Alejandro and Marco were to be on the beach. It reminded me of our “beach week” each summer in Ocean City. I’m pretty jealous of my brothers, I don’t think Ocean City MD really compares to this Caribbean beauty, the pictures tell it all. I spent Saturday and Sunday enjoying the pool and the beach with my aunts, uncles, cousins, grandmother, parents, and brothers. Wonderful company, good dominican food, and a beautiful beach- enough said!

The pool just yards away from the apartment patio

The view of the ocean

 

With Alejandro on the beach

Sosua - probably my favorite beach on the Northern coast

This past weekend I took a three day trip to the south with a group of Dominican and American friends. There were 14 of us in total, we camped out on the beaches, cooked over fires, bathed in rivers, and enjoyed arguably the most beautiful vistas in the country. We traveled in a bus with a driver that we hired and we went from Santiago to the capital, Santo Domingo, then through Bani to Bahía de las Aguilas. To give you an idea, it took us from 10:30am until 10:30pm to travel from our last stop back to Santiago. (Check out the map to see our route!). Let’s just say, my camera got a great workout. It was quite an experience camping on the beach. I was blessed with a wonderful group who planned well and provided great company. We all pitched in and returned to Santiago with about 800 pictures and countless stories. I was happy to return to my bed and shower, but I secretly missed the fun sleeping in tents on the beach and stopping the bus whenever we found a river to all jump in with bathing suits and soap. The pictures tell the story 🙂

 

The blue line and flags represent our route

Group pic!

Las Dunas de las Calderas

From the lookout at the Dunes

The guagua

Salinas de Bani - salt mine

 

A view of San Rafael

Unloading the guagua to set up camp

San Rafael - a river flowed into the ocean

What a beautiful place to sleep!

Woke up to see the sunrise over the ocean

The way the river flowed into the ocean was beautiful

En route to Bahía de la Aguilas

 

A quick stop at Pozos ecologicos

 

Almost there...

On the boat to get to Bahía de las Aguilas

 

Another view from the boat

 

The amazing vista was worth the long trip!

 

The sunset at Bahía de las Aguilas

My favorite picture of the trip!

The view from my tent when I woke up 🙂

We really enjoyed our baths

 

One last amazing vista to top it off

And now for my research. I have learned so much that I want to share and I have realized that it is impossible to do so without a conversation. HEALTH SYSTEMS ARE INCREDIBLY COMPLEX. Why, you might ask? Here’s my opinion: Health care exists at the intersection of business and public service. Health is seen as a human right and therefore should be guaranteed but quality of health care is dependent on resources that are available in the health market. There are questions of finance, accessibility, and quality. Health care is also a very interesting mix of goods and services. So, the challenge is combining the aspects of business markets and public service institutions to provide health care.

An update on my paper: it is now about 20 pages (phew!) and I am also working on a powerpoint presentation. I promise to print a copy for whoever wants one 🙂 My paper first compares a sampling health insurance systems from different countries then explains the demographics of the DR, the health situation here, and then the insurance law. I have done most of my research in Spanish but am writing my paper in English. I will probably write parts of it in Spanish as well as the presentation because on of my professors would like to use the material for her class. My Spanish has improved so much in terms of vocabulary from my research! It’s actually getting challenging to express myself in English sometimes. I find myself using the grammatical structure in Spanish or only thinking of the Spanish word to explain something.  I am writing interview questions that plan to target the financing structure that is in place and education that medical professionals and patients receive about the law because these are two areas where I have noticed there to be gaps in the logic of the system. The financing system is such that the employee ALWAYS gets a percentage taken out of his/her paycheck regardless of the amount he/she makes. But, the government will help the employer cover the rest of the health insurance expense. Is this guaranteeing the employee quality heatlhcare? Another interesting observation is that this insurance system pulls from MANY governmental, non-governmental, public and private organizations. The network of services and financing is complicated. Seems as though instead of pooling resources, they are pulling a little bit from here and there. I am curious to know how this actually plays out- do the hospitals who care for patients with this public insurance really get paid?

Of course this is a very complex topic and I learn more and more everyday and cannot wait for interviews to come to some conclusions! So for now, here is my outline of the Social Security law that guarantees (apparently) every Dominican with health insurance. I would love to read the law in the States…although that might take me a few years (and I thought this 70 page law was a lot!).

Ley No 87-01

Sistema Dominicano de Seguridad Social

Key of Acronyms:

–       SDSS: Sistema Dominicano de Seguridad Social

–       DIDA: Direccion de Informacion y Defensa de los Afiliados

–       ARS: Administradora de Servicios de Salud

–       PSS: Prestadora de Servicios de Salud

–       AFP: Administradora de Fondos de Pensiones

–       SESPAS: Secretaria de Estado de Salud Publica y Asistencia Social

–       CNSS: Consejo Nacional de Seguridad Social

–       SNS: Seguro Nacional de Salud

–       SSRL: Superintendencia de Salud y Riesgos Laborales

–       AMD: Asociacion Medica Dominicana

–       CONEI: Consejo Nacional de Estancias Infantiles

–       SFS: Seguro Familiar de Salud

Objective of the law: To establish the system of social security in the Dominican Republic to regulate and develop rights of the citizens and finance the protection of the population against risks of old age, disability, survival, sickness, motherhood, infancy, and job risks.

Goal: Have the entirety of the Dominican population enrolled in the social security system within 10 years of implementation. (Implemented in 2001, planned complete enrollment 2011)

Principles of the law:

1.     Universality – the law protects all Dominicans living in the Dominican Republic and abroad

2.     Obligatory – participation is obligatory

3.     Integrative – everyone has the right to sufficient protection that guarantees satisfactory life

4.     United – the benefits of social security are coherent

5.     Equal – access to all services is guaranteed to everyone benefiting from the system

6.     Solidarity – everyone will have access to all services for a cost that is determined based on salary

7.     Free election – the right to select the health facility that is accredited

8.     Separation of functions – administration, finance, planning, and assignment of resourced from SDSS are exclusive to the state and are autonomous

9.     Flexibility – the subscribed members select health benefits

10.  Participation – all social sectors and institutions involved in SDSS have the right to participate in decisions made about the system

11.  Gradual – the development of the social security system will be progressive and constant with the objective of covering the population with quality health care

12.  Finance equilibrium  – there will be correspondence between guaranteed benefits and financed benefits

Beneficiaries of SFS include:

–       the worker inscribed in the insurance program

–       the family of the worker: life partner, children 18 and under, children 21 and under if they are students

Education about social security system: The Secretary of State of Education is required to include an educational segment in the basic and medium level public schools about the social security system in order to explain the characteristics, rights, and options of the social security program.

Financial Regimens and Benefits

1.     Contributive: financed by the workers and employers, including the State as an employer

a.     How payment is delivered: the employer pay SDSS within the first three days every month

b.     The base contribution is the minimum national salary multiplied by a factor in accordance with the level of social status of employer

c.     10% of the salary is spent on health insurance- 3% from the worker and 7% from the employer

d.     Benefits

i.     Basic health plan

1.     Promotion of health and preventative medicine

2.     Primary health care, including emergencies, ambulatory services, maternity and infant care, and pharmaceutical assistance

3.     Diagnostic exams

4.     Dental preventative pediatric care

5.     Physical Therapy and rehabilitation when prescribed by doctor

6.     30% of medicines are covered

ii.     Infant care services (CONEI)

1.     Diet education appropriate for age and size

2.     Maternal and infant health services

3.     Pre-school education

4.     Activities for psychosocial development

5.     Recreation

6.     Subsidies for illness and maternity care

iii.     In the case of an illness that is not caused by work, worker has the right to a monetary subsidy for temporary inability to work

e.     Any services not included in the basic health plan are covered by the patient

2.     Subsidized: financed by the Dominican government

a.     Budget will be determined by SESPAS

b.     CNSS determines the criteria and indicators of the population that classify for this Regimen

c.     Benefits

i.     Basic health plan

1.     Promotion of health and preventative medicine

2.     Primary health care, including emergencies, ambulatory services, maternity and infant care, and pharmaceutical assistance

3.     Diagnostic exams

4.     Dental preventative pediatric care

5.     Physical Therapy and rehabilitation when prescribed by doctor

6.     Essential medicines are free

ii.     Infant care services (CONEI)

1.     Diet education appropriate for age and size

2.     Maternal and infant health services

3.     Pre-school education

4.     Activities for psychosocial development

5.     Recreation

6.     Financed by SFS through SDSS, resources from the state, resources from institutions and private businesses, and donations

d.     Any services not included in the basic health plan are covered by the patient

3.     Contributive-Subsidized: partially paid for by the worker, the employer, and what cannot be covered by the employer is covered by the government

a.     CNSS determines the criteria and indicators of the population that classify for this Regimen

b.     CNSS determines the distribution of cost per worker for the basic health plan between the worker, the employer, and the state

c.     Benefits

i.     Basic health plan

1.     Promotion of health and preventative medicine

2.     Primary health care, including emergencies, ambulatory services, maternity and infant care, and pharmaceutical assistance

3.     Diagnostic exams

4.     Dental preventative pediatric care

5.     Physical Therapy and rehabilitation when prescribed by doctor

6.     30% of medicines are covered

ii.     Infant care services (CONEI)

1.     Diet education appropriate for age and size

2.     Maternal and infant health services

3.     Pre-school education

4.     Activities for psychosocial development

5.     Recreation

6.     Financed by SFS through SDSS, resources from the state, resources from institutions and private businesses, and donations

d.     Any services not included in the basic health plan are covered by the patient

System of organization

1.     CNSS: public, autonomous entity that is the superior of the system

a.     Includes representatives of SESPAS, AMD, health professionals

2.     Tesorería de la Seguridad Social: responsible for the collection, distribution and payment of the financial resources of SDSS and the administration of the information system

3.     DIDA: defends the rights of the workers

4.     SSRL: public autonomous supervising group

5.     SNS: public and autonomous entity

6.     AFP: entity of public, private, or mixed character

7.     ARS: entity of public, private, or mixed character

8.     PSS: entity of public, private, or mixed character

Minimum requirements to be accredited as ARS or SNS (public or private entities that administer the basic health plan under the SSRL)

1.     employees who follow the social security law

2.     administration and financial stability cabably of administering the services set forth by the law in efficient, competitive and economically solvent conditions

3.     organize a network of local service providing the basic health plan

4.     guarantee employees a salary

5.     install a system of information including formal reports and statistics

6.     accredit capable supervisors of PSS

7.     accredit periodically the minimum level of technical finance established by SSRL

8.     determine an operative capital paid in cash proportional to the benefiting population

Levels of attention required of ARS or SNS

1.     primary attention with an entrance and network of services and professional attention

2.     a level of ambulatory attention with capable professional attention

3.     the ability to place patients in hospitalization care and sufficient human resources to attend to the demand of patients

4.     system of reference from primary attention to other levels of necessary attention, specialized attention or hospitalization

5.     preventative services and recourses provided and financed by SESPAS





Zona Franca and Mangos…?!

27 02 2011

My “Procesos” class has proved to be more interesting than expected. We took a field trip to a “Zona Franca” or Free Zone in Santiago. Free Zones exist around the world and are characterized by special regulations relating to the taxes that multinational companies pay to import and export products produced in factories in these zones. In the Dominican Republic, the factories are owned by Dominicans and employ Dominicans but produce goods for international companies. We visited a factory that produces shoes for Timberland. It was incredibly interesting to tour the factory and talk to the manager and workers. Most of the employees said that they didn’t love their job but they also didn’t hate it. They appreciated the stability and benefits that the employment provided but complained about the repetitive nature of the work. I had imagined an oppressive, hot environment with everyone is isolated sections not able to talk for 8 hours per day. I was pleasantly surprised to find a large open room with music over the speakers and lots of conversations. The building was divided into sections where each part of the shoe-making process took place. We toured through and saw each step, it was very interesting to see a loafer-type shoe made from start to finish. With the visit came a lecture on the economy of the Dominican Republic. It was originally an agriculture-based economy but now it draws the largest incomes from zona francas, tourism, and remissions. It went from a self-sustaining economy producing for Dominicans and exportation to an economy almost completely dependent on foreign money and production for exportation. Interesting to consider if this is the reason for the economic situation that the country now faces.

We took a day trip to Parque Nacional Isabela which was where the first colony in the Americas was built. Unfortunately, when Trujillo was in power he ordered a General to “clean the site up” because a European group of archeologists wanted to come and excavate it. The General interpreted “clean it up” as bulldoze all of the ruins from the original buildings into the ocean! So now, there is not much left but a few foundational pieces and a small museum with some artifacts that were salvaged. We also learned a lot about the history of Columbus’ trips and the information lines up really well with what I’m learning in my Caribbean History class. After the national park, we spent the afternoon on the beach! We visited the first beach that Columbus swam in and then another beach that houses an all-inclusive resort. I have a new rule: I have to spend at least one day per week on the beach. I’ve realized that I won’t get to be on beaches this beautiful for a while, so I need to take advantage while I can!

Playa Grande

Playa Castilla

La Parque Nacional Isabela

My classes are plugging right along. My professor in the medical class is still in awe that I can handle myself. Someone was giving a presentation and he stopped him, asked me to read the slide aloud, and explain what the slide meant. It was about the Hippocratic oath, the part about how doctors should respond to euthanasia. I explained and he was shocked, told me for probably the forth time: “so you can speak Spanish”. Yes, yes I reassured him, I understand everything that’s going on in this class. After class he called me up and told me that anything I needed he would be happy to help. I’m glad I’ve caught his interest because he is going to be a perfect interview subject for my project.

My research is going very very well. I have finished reading the entire social security law (all in Spanish…phew!) and I have it outlined. The next step is to re-outline the parts specific to health in English and define any government organizations in order to really understand the policy and target parts that I want to focus on in my interviews. I have a meeting with my professor this week and will start setting up interviews with doctors, hospital administrators, business owners, and patients. I will eventually post my outline and description of the law but so far what I have found most interesting (and also problematic) is the way in which the Dominican government proposes the financing of this system- they use a mix of public and private funds on a sliding scale based on salary. From what I saw this summer, this mix of funding isn’t working exactly as planned. I’m excited to dive into the interviews!

In other, perhaps less important news, I ate a mango today!! I can’t tell you how much I have been dying to eat a mango and it was absolutely delicious. They really aren’t in season but they are going to start coming out in March. I can’t wait; the mangos in the states just don’t even come close. I spent a wonderful evening with my family at the Centro Español, it really is very nice there. Tomy plays in a softball league so we went to go and watch (and also take advantage of the delicious food that they serve). There is also a gorgeous view from the patio of the restaurant that overlooks Santiago.

The view from the patio in el Centro Español

Mary and Alejandro – que bellos!





Constanza

18 02 2011

I had promised this post earlier in the week, and I swore that I had time, but somehow it is already Thursday…

This past weekend we went with the program to Constanza, which is a mountainous town in the region of La Vega characterized by gorgeous vistas and the coldest weather on the island. Excursions with the program are always well planned and enjoyable because it’s like being on a tour for three days. Everything is included: a nice room in a hotel, three huge and wonderful meals per day, and well-scheduled activities. The ride to Constanza was windy and steep, some of the girls took Dramamine to make it through, I am lucky that I don’t get any sort of motion sickness. The vistas along the route were just incredible; I couldn’t help but get out my camera and start snapping even through the windows of the bus. When we arrived at the hotel I got very excited. The hotel was called “Altocerro” and it was a collection of small villas that each housed five people. We were divided into groups and sent to check out our homes for the weekend: two floors the top floor with full kitchen, dining area, sitting room, TV, and patio and the lower level with two rooms with a bed for each person and a bathroom. The next activity was lunch. I can’t even begin to tell you how wonderful the food was for the entire weekend- I probably ate enough to last me the month. After lunch we had the option of going on a hike or visiting a flower garden, I bet you can guess what I opted for.

The “jardin” was more like a flower factory, it’s one of the largest producers of fresh cut flowers in the Caribbean. There were rows and rows of tarp-type structures that housed many different types of flowers (and even one with tomatoes). We toured through the cold rooms where the seeds are housed before planting and the freshly cut flowers are kept before shipping them out. Because we were there on the Friday just before Valentine’s Day the majority of the stock room was empty but we did get to see them dye some white carnations red! We had some time after the garden so we visited some ruins of a hotel that was built during Trujillo’s regime. We toured through the old building complete with spacious suites, patios, and a beautiful view of the mountains. Trujillo (the dictator of the Dominican Republic from 1930-1961) built the hotel to have as a get away from the city and enjoy the tranquility and fresh air that the mountains provide. After his assassination, instead of rehabilitating the hotel it was left in an effort to try and forget Trujillo and the mark he left on the country.

Then, it was time to eat again. [Side note: I am currently writing this as Marco is climbing onto my lap in order to color with my highlighters the Dominican flag]. After dinner we had the night free. Three estudiantes de apoyo (the support students from the university) accompanied us on the trip and one had a friend from the university who also had a house in Constanza and often spent the weekends there. A quick phone call and we were off to explore the small town and enjoy the night life. It was SO different from the night life in the city. We all pulled up chairs around a garage like structure, where people were scattered in plastic chairs and some dancing. The only type of music that were played were reggaeton, bachata, merengue, and a bit of salsa- nothing American.

The next morning after a huge breakfast complete with the queso frito, mangu, papas, jamon, pan con mermelada, chocolate and café (all of the Dominican breakfast favorites), we boarded a safari type bus to make an hour and a half trip to Aguas Blancas- a waterfall that is a must see in Constanza. The ride was on a dirt road up a mountain, and yes, there was more Dramamine taken. The waterfall was beautiful and a few of us were even brave (or crazy) enough to go swimming in the water under the fall!! It was absolutely freezing but so much fun! My thought process went something like this: I just spent an hour and a half on a dirt road in an open bus jumping up and down in my seat to only take pictures?!…I have to get in the water. Basically the five of us put on our suits, made our way down the rocks, jumped in, took a picture screaming at how cold the water was (probably about 40 degrees F), and jumped out. Needless to say, it made for some nice Facebook albums.

After, we ate (again) we had the rest of the afternoon to spend exploring the grounds of the hotel, napping, and doing homework before dinner (yes, more eating). I had brought my computer with me so we did “Insanity” (the workout schedule I have been following that consists of videos) on one of our patios with the beautiful mountainous vista as our backdrop. Pretty cool, I must say. After our workout session we caught a ride on some motos and headed into town to take a tour. I have to say, it was a lot of fun riding on the back of a moto and I felt safe because there is barely any traffic throughout the town. After about an hour tour we headed back to the hotel and had a cookout complete with bonfire and traditional dancing under the stars. The next morning we had free until lunch, so with the help of some more motos, we explored the town a little further. We visited a strawberry farm (many many populate the hills) and some other high points where you could see expansive views of the farms and communities. It was a wonderful morning conversing with the locals and enjoying the fresh mountain air. There were times when I forgot I was in the Caribbean because it was such a different experience from the beach or the city! The locals were genuine and humble. The explained to us that they were incredibly content with their lifestyle- one explained that he felt that he lived better than the President. They live off of the land and eat well, make good money in the agriculture industry, and have access to modern conveniences like internet and cell phones without the hussle and bussle of the city- an interesting perspective. After our tour through town we ate a sizeable lunch and then boarded the guagua (bus) to head back to Santiago.

 

Altocerro- the hotel

 

One of the many beautiful vistas!

 

On route to the waterfall

 

Whoohoo!

 

We made it to Aguas Blancas

The water was about 40 degrees...

 

The moto 🙂





A Typical (?) Weekend

7 02 2011

I put a question mark after typical because I have decided that perhaps nothing can be qualified as typical anymore. On Thursday I thought, ahh finally a nice weekend in Santiago I will study, finish perfecting my article, and maybe do some shopping. I was partially correct. Friday began with some homework and Blackberry problems and concluded with a jazz concert. And somewhere in between I managed to call Sprint, negotiate with the cell phone store here to convince them to try to repair my phone, buy about six articles of clothing (Mom, I know you’re dying, yes more clothes) for under $20, and learn about 50 new medical terms (in Spanish of course). My Blackberry sadly died Friday morning. I am not sure how or why but the keyboard doesn’t work. There are no problems with the service, I was getting calls, texts, and emails but I couldn’t get to anything. You really don’t know how frustrating it is when your phone is vibrating and you know there is something potentially important and you can’t get to it! I am sure that I probably sound like one of those people that is dependent on their Blackberry, and I will admit that I have a very close relationship with mine, but really it is a wonderful tool and resource. Especially here. I can’t tell you how many Facebook messages I have received from my Dominican friends asking why their BBMs aren’t going through- EVERYONE and their mother have Blackberrys because BBM is free with the monthly data plan and the data plan is very inexpensive (I’m talking 1/4th of the price that it is in the States). So, I have been Blackberry-less for a few days now and praying that the people at the phone store here can repair it. I do have a phone in the meantime, luckily I kept my phone that I used last summer, but it just isn’t the same. I seem to have phone problems a lot back home too, I guess relocating doesn’t change some things!

Now to the more interesting part: shopping. A friend of mine is doing some community service teaching English and dance to sex workers. Where she teaches is in the heart of the city near Calle del Sol which is sort of like the Soho of Santiago. (Sort of). Basically a lot of street vendors, lots of retail shops, banks, restaurants, people, etc. She had to teach on Friday and she invited me to walk with her and then spend the hour milling around while she had her class and then accompany her back. It was probably one of the most productive hours of my experience so far. I found the VIVA store (cell phone repair place) by asking various people where it was. Another thing I love about this country, no one uses a GPS because you can always rely on the fact that other people will know where something is. But, you have to be careful because some people don’t actually know. So I have a rule. I ask three people for directions and go where 2 out of the 3 say to go, because without fail, there are always two responses that are the same and one that is different. After the phone store I continued on down the street without any goal or expectations, I just wanted to observe. This wasn’t my first time to Calle del Sol (in fact, I can’t even count at this point how many times I’ve been) but this was my first time back since the summer. It looked the same but the experience was different. This time I understood the piropos, felt more comfortable talking to the people, and there were masks and other costume items for Carnaval everywhere. I perused in and out of various stores- made some friends with sales people who asked me at least five times where I was from because “usually the Americans that come here can’t speak any Spanish”. I thoroughly enjoyed my time just absorbing this central part of the city. I think when it’s time to pick up my phone I will factor in an extra hour 😉

Saturday I went with my family, which was my host mom and dad, two uncles and an aunt (and yes, we all fit in one car) to the capital for a Baby Shower. The first thing that I found to be interesting, they call it a “baby shower” and all of the favors and decorations were in English. Apparently, there is no Spanish translation- or perhaps it’s just another example of how much American influence is present here. But before we got to the baby shower we went to IKEA. Dominicans love IKEA. And I have to say, I really like it too. There is so much stuff in that store. It’s like stimulation overload. It was great for my vocabulary because all of the signs were in Spanish. I asked Mary before we went in if there was anything in particular that she wanted and she responded “no, but I’m sure I will come out with more than a few things”. Sound familiar, Mom and Dad? And she was right. A few things for the boys room, a new CD/DVD rack, some plates, and even a watering can. After IKEA we went to Quizznos to grab a bite to eat. Food is very inexpensive here, with the exception of all of the American chain restaurants- they are more expensive than in the States. They import everything. If I could make one suggestion to improve the economic situation, it would be to eliminate chain restaurants. Perhaps this would encourage more Dominican businesses and stimulate the agriculture here. Next came the baby shower. It was held at a country club type place that was for families of government officials. There was an open bar, traditional music, baby shower games, and lots of laughs. I have never been to a baby shower in the States (at least not that I can remember) so I am not really sure about the customs, but here the entire family attends and the alcohol flows. (Mom thinks the latter is why people here are always so happy, she might be right).

 

At the Baby Shower with the Mother-to-be

Sunday I went to Carnival in La Vega. I was SO EXCITED and my excitement was met with a wonderful experience. My uncle has friends who got us free passes to the VIP section hosted by Brahma Light (a Dominican beer). VIP meant free and unlimited food, drink, and a wonderful view of the festivities from above. Here is a little history about Carnival: Carnival is celebrated the entire month of Febrero/ February filling each weekend with parades, events and competitions. Each town offers their own twist to the event. The celebration climaxes on or near the 27th of February, Dominican Independence Day. It is an experience that everyone should have sometime in their life. Visitors and Dominicans alike wait with anticipation for this time of year. The celebration brings with it so much color and tradition from the vivid colors of the costumes, the spirited music and lively dancing. The droves and crowds of humans with voices raised. Experiencing the electricity (even if the electric power may be out) coming from the participants and viewers alike as all join in the festivities. Carnival is a true Dominican experience. The use of masks to symbolize spiritual, supernatural and unknown spirit world entities has been used since before recorded history. Africa tribes and Native Americans, among the many ancient peoples, used masks to either depict, get the attention of, or to hide themselves from a higher, or more spiritual being. The natives of the island, the Tainos, and the natives of the surrounding islands had their own festivities long before the arrival of the Spaniards. Their celebrations were called areitos. Mainly they were to commemorate planting and harvest times. They also honored weddings, death and other significant happenings in their lives with these celebrations. They would use body decorations, tattoos, paint, jewelry, and masks during these festivals. With the arrival of the Conquers and the African slaves they brought with them carnival celebrations evolved. The African peoples brought with them their own festivals and celebrations. These contributed the vibrant colors, and some of the traditions of making frightening masks, the musical instruments, dance and songs. They also gave a little humor to the mix by making fun of themselves and life. It was a way to escape the hardships of life. Making their existence a little easier to bear by making jest of themselves and their circumstances. The most popular Carnival activities are in the town of La Vega. Normally a very quiet town with not much tourists draw. Durning carnival here is where thousands of people go every Saturday and Sunday during the month of February. People gather on Calle Padre Adolfo (with the cathedral lurking in the distance), in front of the Parque de las Flores or to watch the spectacular event. The registered groups, known as comparsas, participate in the Carnival parade. These groups can be well organized. Many have participated together for many years. The groups may include from 10 to 15 people and sometimes many more. The traditional costumes are carefully sewn months in advance and are very intricate and colorful. (http://www.colonialzone-dr.com/traditions-carnival.html). The streets were flooded with people and there is a tradition that makes Carnival a bit dangerous. “Amongst all the colors, activity and music in abundance one must always be on high alert for the vejigas/ the inflated bladder weapons and the látigos/ whips. The vejigas are a balloon type weapon dangling at the end of a strap, toted by these wicked creatures. These balls are traditionally made of either cow or pig bladders and filled with air. They are also sometimes made of rubber these days. These are used to hit the people that happen to get in the way. Always aiming to hit on the lower part of the body but with all the commotion in the street it is a free for all. Originally these balls were used as crowd control to make way for the costumed peoples. It is said that getting hit brings good luck. I think it is more lucky if you can avoid being hit. I suggest staying away from these weapon-bearing creatures because getting hit hurts. Getting wapped in the butt is not pleasant but it is all part of the Carnival experience.” Yes, I was hit, luckily not too hard. And only once on our way to the safety of the VIP area. The experience was just as it is described above, lot of music, people, energy, and smiles! The costumes are absolutely incredible- I am so happy to have my Nikon to help me capture the beauty and intricacy of the different costumes. The program brings us to Carnival as a group but I don’t think we get to be VIP. My uncle said that when the program takes us to let him know and he will get me (and perhaps a few lucky friends) some passes!

 

Carnaval, La Vega

 

VIP- Brahma Light

 





Semana 3/4

3 02 2011

Well, my plan has failed me in a sense. (Of course) I had a plan to write my blog posts every two weeks. But I have realized that with the timing of things it will probably be best to write when something new and exciting happens (which is basically everyday, by the way) so after this post I will follow my sister’s example and write on experiences rather than on a timeline.

About two weeks ago now, I met with a professor that I had this summer who works in the Ciencias de Salud department at PUCMM. She is essentially the go-to woman in public health and helps to coordinate Juan XXIII, which is the public health system of hospitals, clinics, and community educators that was established between the university and various government organizations. She is (obviously) a wonderful resource for my project. After the initial shock of seeing the “rubia” again, and I explained to her what I was doing back in the country, she was actually jumping with excitement. In her rapid fire Spanish she explained that I could absolutely continue to work in la Zona Sur in order to be around lots of medical professionals and public health workers and have access to community members. She also explained that she would put me in contact with all of the administrative people that have information about the policy specifics. I can’t tell you how excited I was that she was excited. I have found that here, all you need is a smile, the ability to communicate, and evident interest and you can usually find what you need. At the conclusion of the meeting she told me to get a letter from my director explaining that I had permission from Yale and PUCMM to investigate seguro social and conduct interviews and that she would then help me set up a schedule for working in la Zona Sur and starting to make contacts with medical professionals and health administrators.

My classes are going extremely well. I really enjoy each and every one! In Caribbean History we are learning about the indigenous populations that existed in the Caribbean before the Europeans began the conquest. We have learned where the people originally came from, the theories about how they traveled to the islands, and how they established their towns. We also had to write an exposition about the definition of the Caribbean after reading an article that explored the various components that make up “la mezcla” (mix) that is the Caribbean. It’s an interesting area of the world to study because it can be defined many different ways geographically, culturally, and economically. Because of the way in which it was discovered and colonized by various powers, it developed into an area with a variety of cultural influences. There are four main languages spoken, a variety of religions are practiced and African and European influence can be found in the food and music. My Spanish class has a sociolinguistic focus so we are focusing on how Dominicans speak Spanish. It is so engaging because each class we review words that we’ve heard in the streets or read on signs that are specific to the Dominican Republic, or sometimes Latin America. It’s really good practice for my vocabulary and I blend in more and more with the Dominicans! We just spent some time working with “piropos” which translates into compliments. Piropos are the comments that men (and boys, they start young) yell out to women in the streets. I’m the victim of piropos everyday, multiple times a day, simply because I am white, American and a natural blonde. Usually I get things like “rubia, mami, venpaca” or “Americana tu eres tan bella”. Sometimes, they get really creative. “Si tu caminas como concinas, guardame un chin de con con”, or “tu crees en amor de primera vista o debo pasar otra vez”. I encourage you to try and translate those, but the beauty of them is that there are references to things you will only know if you are Dominican or have spent a lot of time here. Piropos, in a sense, are metaphors and part of the culture, like an art form. The piropos definitely represent the machismo that exists here. Occasionally, they are genuine. There is an older security guard who works in my neighborhood and every morning he greets me with “buen día rubia bella te Dios te bendiga”. My direct enrollment class, History and Anthropology of Medicine is divided into two parts. Right now we are learning the meaning of all of the roots of medical terminology. It is extremely practical information (after all, I am in class with soon to be doctors). It’s been a bit of a challenge because sometimes I don’t know the concept in English much less in Spanish! But, it’s a wonderful experience and I am just going to be a step ahead when I finally get to medical school. I have to say, it’s frustrating being in a class with Dominicans who are my age and in two or three more years will be graduating with their medical degree already! I look around and think, wow, while I am just starting medical school they will be writing prescriptions. But at the same time, they tell me they wish they could have gone to the states for medical school. After all, they say, if you have a medical degree from the United States you can practice anywhere you want. (I hope they are right!). My class on the socioeconomic and political status of the Dominican Republic was slow at first but is definitely catching my interest. We started by learning about Trujillo who was the dictator here for 31 years from 1930-1961. His dictatorship was oppressive and he is blamed for many of the problems that the country faces today. We have also been learning about the structure of the Dominican government, which is technically a democracy, and also (and more interesting) the political culture here. More to come on this political culture a little later in this post.

We had a long 4 day weekend, so of course, we went to the beach! Not just a beach on the northern shore, however, a beach called Barvaro which is part of Punta Cana on the southern shore. It was beautiful, like nothing I had ever seen. It was just as beautiful as Bermuda but different. The sand was perfectly white and very fine, the waters of the Caribbean ocean were at least 5 different shades of blue/green, and the palm trees added that postcard touch. We had perfect weather and lots of time to enjoy the sun. I had organized the trip with a friend and a total of fifteen of us went! It was fun, but needless to say, I don’t think I can organize another large group event anytime soon. I sort of felt like I was the mother and every 30 seconds someone needed something or someone didn’t agree with the plan or lo que sea. Mom, I have an inkling of how you must have felt at all of those birthday parties that we had when we were younger! But, the beach was beautiful and a 6 hour trip from Santiago, so gracias a Dios we had four days to enjoy it!

Barvaro- White Sands

The girls!

When I returned from Barvaro I got right to work because I agreed to write an article for the Yale Journal of Public Health. The coming issue is all about food and how food influences health. This past summer I had focused some of my time on studying diabetes here in the Dominican Republic when the email about the upcoming issue, I thought it would be really interesting to include an article from abroad, having a global perspective is always interesting. I proposed to write an article, here was the lead: Diabetes affects more than 220 million people worldwide. When the pancreas does not produce enough insulin or the body cannot effectively use the insulin that it produces, raised blood sugar can lead to seriously damaging effects. Type II diabetes is preventable and Type I can be managed so that people at risk of or living with diabetes can live to the normal life expectancy with minimal consequences. Yet, people still die from this chronic disease and 80% of the deaths occur in low and middle-income countries. What are the barriers preventing people from receiving care? How does the food industry influence the food choices that people make, especially those who live below the poverty line? Does education about prevention and management enhance understanding enough to manage diabetes?

I interviewed one of my friends who is a doctor to get some basic facts down and he told me about El Centro Diabético that exists here in Santiago. So obviously, I went to check it out. The thing that I love about this country is that people are always willing to talk to you and help you. (Maybe it’s because I’m blonde and I can communicate well, but regardless it’s a big perk!). I conducted some interviews and learned a lot about the impact of diabetes here and how the public health system has been constructed to care for diabetic patients. I don’t want to give it all away, you will have to read the article when it’s published (it’s about 3,000 words) 😉 I absolutely loved the experience, though, and it was a wonderful “warm-up” for the interviews to come with my research on the insurance policy.

Speaking of that research, it is going extremely well! I have an outline and I have already completed part one. The general plan is to research the following: 1) the history of health insurance, 2) current systems of health insurance in certain countries, 3) case studies on Caribbean nations, 4) health insurance here in the Dominican Republic. I decided that in order to really understand the health insurance policy here, I needed to understand policies that other countries have in place. I started working on part 2 first because I want to make sure that I have plenty of time to delve into my case study on the DR so the history of health insurance section may wait until the end as I am compiling all of my research. So far I have information on the current insurance systems in the US, Canada, India, China, Spain, Colombia, Cuba, and the Dominican Republic. I chose these countries as a sampling from each area of the world. I am going to start writing my first chapter for my final thesis as well as draft slides for my presentation. My advisor suggested that I write as I go so that everything is fresh and I can invest fully in each part. (Not to mention that one of the professors would like me to publish in an article here and in Latin America at the end of the semester so I need to write as I go, and in Spanish!). After I finish writing this chapter, I will continue with more detailed research into the history of insurance in the Caribbean specifically and the logistics of each system in order to place the system that exists in the DR into context. I can’t put into words how much I am enjoying learning all of this- and I think it’s going to help me immensely for my Masters! (That was the plan 😉 )

My week concluded with a David Guetta concert and a Sancocho competition. Let me explain. David Guetta is possibly my favorite artist. He is more or less a DJ/producer. He came to Santo Domingo, so obviously, I bought a ticket. I went on a tour, which meant that transportation to and from the capital was provided; I got a tshirt, food, and drinks. We left Santiago at 7pm and didn’t arrive back to Santiago until 7am the next day! The concert itself was incredible, and I even snuck my camera in!! Usually they don’t let you in with a professional camera, but I found a way, and I have some amazing photos.

At the Guetta concert!

The next day (after sleeping for the majority of it) I went with my family to the Centro Español to a Sancocho competition. The Centro is more or less a country club and they have various events that you can sign up to participate in. Sancocho is a traditional Dominican food that is like a stew made with various types of meat, potatoes, plantains, yucca, and corn. It’s absolutely delicious. The idea was that each family/group made their own Sancocho and then they were judged and the top 4 won prizes. We made the sancocho over fires in large pots, the pictures describe it best. There was also a live merengue band! I love merengue. And apparently I dance pretty well. People kept checking to make sure I was American! They also had other typical music and I got to dance some salsa as well. That is probably one of the things that I had missed the most, the dancing. It’s a joyous thing, everyone participates, it’s fun and light-hearted, and it’s not that obnoxious (Toad’s style) American dancing. New goal: go to more discotecas with traditional music to keep practicing my skills!

Competencia de Sancocho

With Laura ("Tia") at el Centro

Sancocho- yum!

In more recent news there was a riot/strike (una huelga) yesterday (Feb 2). According to dr1.com, the largest English Dominican news source, “Public transport drivers serving several “concho” routes disrupted traffic along 27 de Febrero, Estrella Sadhala and Juan Pablo Duarte avenues yesterday in protest at the new routes approved by the city council. The drivers, members of the Fetranreno union blocked the roads in the morning and part of the afternoon. According to Hoy, one person was injured and several windows were broken, and city officials complained of the fact that while the demonstrators blocked the access to the municipal office, the Police did not do anything. According to reports, at least six people were injured in other protests. El Caribe said that at least one person was injured in Monte de Jagua, and another two between Moca and San Victor in protests that extended throughout the Cibao region over the higher fuel prices and the cost of living.” What’s very interesting about this is that just two months ago there was a huge movement here called “4% para educación”. The people encouraged the government to allocate 4% more funds to the public education system here. The government did not grant any more money for education but did raise gas prices, food prices, and the cost of public transportation. Here are some interesting statistics: in 2008 a barrel of petroleum cost between $140 and $145. Gas in the DR cost 140 pesos (about $4). Today a barrel of petroleum costs $90 and gas in the DR costs 180 pesos ($5). Why is it that petroleum costs less but gas in the DR costs 40% more? The answer: taxes. Who imposes these taxes?: the government. People are frustrated because there are less jobs and yet the cost of living is climbing. We learned in our class that there is an attitude of “paternalismo” when it comes to the government. Dominicans view the government as a father that is supposed to provide and provide unconditionally. There is an obvious flaw in this way of thinking, a democracy required involvement from the people, and otherwise all of the resources end up in the hands of very few. But, candidates use this attitude to campaign. The next presidential elections will take place in 2012 and there are already posters up for candidates. One of the candidates uses the slogan “Llegó Papá” (Dad has arrived). It will be interesting to keep following this because if something like this were to happen in the states, the government would respond immediately. But has the government made any announcement here? Not that I have seen- it’s as if they turn a blind eye.

Look for the next post soon- I promise to keep them coming more frequently! Enjoy the pictures!