Our six weeks in the Dominican Republic gave us a chance to put everything we learned during our first year as Maternal and Child Health students into some intense practice. The gist of our field experience was to create, administer, and analyze data from a community health survey in an agrarian region of the Dominican Republic. The nitty-gritty of it, though, turned out to be both far more difficult and interesting than we could have anticipated.
Our field experience was coordinated through a nonprofit clinic called the Batey Relief Alliance (BRA) which provides primary medical care services for several bateyes in the surrounding area. Rural Haitian immigrant communities, known as bateyes, are remnants of the Dominican’s turbulent past: constructed during the dictatorial Trujillo Era, the cement barracks were once home to thousands of Haitian immigrants who hoped to find economic prosperity cutting sugar cane. Today, many Haitian-Dominicans live in the bateyes, but within the Don Juan region the sugar cane industry is gone. Without the sugar cane industry, these areas are almost entirely lacking in economic opportunities. Some individuals leave their families during the week to travel to the capital city for work, and others take seasonal work in farming and agricultural jobs.
Every day, we went with a health promoter into one of the bateyes surrounding the BRA clinic. Lucy used her Spanish to ask the head of household questions about water quality, sanitation, and skin and diarrheal diseases while Julia and Marie took notes on living conditions. We used this information to create a self-reported community profile of disease prevalence and living conditions.
Methods we learned in our epidemiology classes, as well as input from the clinic director and health promoters,
helped us form culturally and regionally appropriate survey questions that would provide the information we needed. We also learned the importance of cultural sensitivity while visiting people in their homes. This concept had been stressed time and again in several of our maternal and child health classes. We were able to work best within the culture when we were flexible about our time frame and sensitive to cultural norms and approaches to daily life.
We used a qualitative approach to determine socioeconomic status, such as asking about housing structure and ownership. As the study progressed, the valuable information we gathered made us wish we had the time and resources to further explore the social determinants of health in these communities.
This project hugely reinforced to us the importance of performing a pilot study. As we collected and analyzed our data, we regretted not having asked things differently or taken more detailed or standardized notes on various issues. A pilot study would have helped us to find and address these problems early on.
As we put together our survey responses, we applied lessons from our epidemiology classes to take into account our study’s limitations and make the most of its strengths. As with any self-reported information, we knew our data were subject to recall bias. Additionally, one person would provide information for their entire household, and sometimes answers were contradictory. Finally, it was impossible to take a truly random sample because the bateyes lacked formal streets, listed addresses, or even designated town centers.
As for the results of our study, our goal was to provide a community self-reported profile of skin and diarrheal diseases. Fortunately, there weren’t enough cases of diarrhea to provide meaningful data about it. Our data served as an informal evaluation to inform BRA of the success of their water sanitation efforts in the surrounding communities. Skin diseases, however, were prevalent in each batey. These diseases seemed to be linked to overcrowding and distance from medical providers. Our findings reinforced what BRA had already suspected, that addressing living conditions and access to health care would be important steps towards decreasing the prevalence of skin diseases in the region.
Lucy Cosgrove and Julia Shumway are graduate students in the Maternal and Child Health Program at the University of Minnesota.