Keelin (Caoilfhionn) Roche
Date of Defense:
April 26, 2019
Introduction: Though the Dominican Republic and Haiti share a border, the demographics and history of the two countries vary; Haiti was first of the two countries to free themselves from French rule. Although there has historically been animosity between these two populations, in the early 1900s, the Dominican Republic promised Haitians work on the sugarcane plantations, thus, creating a migration of Haitians to the Dominican Republic, upon which most Haitians did not return to Haiti. Because of the disdain felt between populations, the Dominican Republic government assigned Haitians to reside in shanty-towns called “Bateyes”. Bateyes have, historically, lacked basic needs, such as running water, electricity, toilets, and proper nutrition. Though many of the sugar cane plantations have shut down, throughout the years, the Bateyes have remained home to second and third-generation Haitians born in the Dominican Republic; no legal status in the Dominican Republic, and without recognition by their home-country of Haiti, they consider themselves to be state-less people. This has created continued lack of resources, support, and poor health in the Batey communities (Wright).
Organization: The Batey Relief Alliance (BRA), a non-profit organization founded by a Haitian-born, New-York-raised man who has also worked in the Dominican Republic, spearheads community empowerment and development initiatives in the Dominican Republic Bateyes through various cross-cultural and cross-continental programs that address food security, reproductive health, environmental health, and medical needs within these communities. The mission of BRA is to unite, “grassroots groups, faith-based organizations, government agencies, and the international community in a strategic partnership to help create a safe, productive and self-sufficient environment, through health care, food security, education, disaster relief, and community development programs, for children and their families severely affected by extreme poverty, disease, and hunger in the United States, Latin America and the Caribbean” (Batey Relief Alliance, 2013).
Although BRA has various programs working towards the empowerment and elevation of the Batey communities, our team of four Maternal and Child Health students were tasked to evaluate and create a monitoring and evaluation tool for their most recent initiative: The Women’s Empowerment Initiative (WEI), which began in 2017. For BRA, the WEI is a comprehensive approach to achieving their great mission; empowering women of the communities through education, training, and micro-loans to ultimately improve the economic and physical health and wellness of families, including men. This creates a trickle-down effect that has been recognized in other women’s empowerment studies within impoverished communities (Batey Relief Alliance, 2017).
The WEI has two main objectives Objective 1: Educate women on effective agricultural planning, production and marketing. Through this objective, BRA seeks to develop, finance and provide technical support for the successful implementation of market-oriented agricultural strategies with 5,000 women living in the targeted communities. Objective 2: Promote preventative healthcare and hygiene practices for vulnerable women and their children. In tandem, the agency will facilitate the provision of maternal-child health and HIV services, and the administration of a nutritional supplements program funded by the USAID to households participating in WEI. The objectives accomplished by our team include: Assisting with surveys and data collection, assisting with the nutritional program, assisting community health workers with HIV/AIDs and nutritional educational activities, development of monitoring and evaluation indicators and data collection tools, and development of logic models using Life Course and Socio-Ecological models.
Experience: In order to meet these objectives and be successful and ethical in our data collection and analysis, the group ensured that evidence-based research and tools were used by first conducting a literature review. We were able to find previously used questionnaires and indicators from empowerment-based studies, and specifically women’s empowerment research in low-resource communities across the globe. The team conducted a community needs assessment, and a thematic analysis from those findings to understand the key indicators and concerns of the community receiving the initiative. Based on the research and indicators, we created a questionnaire focusing on major concerns: sexual health, nutrition, community, and capacity. The questionnaire, again, was derived from evidence-based measurement tools from the World Bank, the World Health Organization, the Global Hunger Index, Food Insecurity in Women’s Empowerment, the Household Hunger Scale, and the Demographic and Heath Survey (Encuesta Demográfica y de Salud) from a study conducted in the Dominican Republic. All questions were pre-tested and pilot tested to ensure cultural and linguistic sensitivity, proper literacy level, and relevance to the objectives of the community and WEI. Measurements and the ability to quantify this data was based on the Women’s Empowerment in Agriculture Index, and the analysis was done using Microsoft Excel.
Methods:This was a small-scale study, given our time-frame (three weeks). The questionnaire was a mixture of ordinal, nominal, and open-ended-questions. Our results, segmented by questionnaire section themes, are as follows: (Decision-Making) 95% of women surveyed talk about the possibility of continuing to study at the university level with their children. 40% of women surveyed strongly agree that their partner considers their financial contribution to be as important as theirs. 50% of women surveyed strongly agree that they are an important part of the economy of their communities. (Nutrition and Hunger) 75% of women surveyed have food insecurity, as evidenced by their responses to the two-question evaluation tool. 65% of women surveyed are experiencing moderate to severe hunger, as evidenced by the Domestic Hunger Index. 70% of women surveyed consume only 0-3 vegetables per week. (Sexual Health) 10% of women surveyed agree that she or her child(ren) has been a victim of violence (physical, emotional, or verbal) in the last year. 30% of women surveyed agree that they insist that their sexual partner uses a condom. 35% of women surveyed agree that they had been sexually active, either orally or vaginally, in the last three months.
Lessons Learned: Through this experience, the group of MCH students and myself learned various lessons and critical skills that will carry us forward in our public health endeavors; to name a few, adaptability, communication, and the importance of community generated research and cultural humility in all public health, particularly global health settings. The team worked cohesively, strategically, and effectively, identifying each contributor’s strengths, and assisting one another to hone developing skills. As a team, we reflect often on the lessons we learned about community involvement and the importance of transparency through communication in these settings. Though we presented specific recommendations to the BRA team regarding the M & E tool and ensuring monitoring compliance at 0, 3, 6, 9, and 12 months, my recommendations to future participants in this field experience is: to be open-minded, be humble, and ensure that one team member speaks the language. Our team’s fluency in Spanish was pivotal in our success in meeting the objectives.
Conclusion: Having the opportunity to work with those involved in home-base logistics and those that are in the field every day was invaluable. Being able to see both sides, hear varying stories, and understand the true nature of the concerns that communities are facing is an incredibly important lesson when approaching a position in a global health capacity. This partnership with the Batey Relief Alliance is indelible to lessons MPH students need to learn as they move in to the Public Health workforce.
- Wright, P. (n.d.). The Origin of the Dominican Batey. Retrieved April 12, 2019, from https://cotni.org/news/dominican-republic/2007/11/14/origin-dominican-batey
- Batey Relief Alliance. (2013). Retrieved April 12, 2019, from http://bateyrelief.org/
- Batey Relief Alliance Launched New Women’s Empowerment Initiative. (n.d.). Retrieved April 12, 2019, from http://bateyrelief.org/2018/07/23/batey-relief-alliance-launched-new-womens-empowerment-initiative/
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- Dominican Republic – Encuesta Demográfica y de Salud 2013. (2014, October 1). Retrieved from http://microdata.worldbank.org/index.php/catalog/2228
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- Simmons, D. (2010). Structural violence as social practice: Haitian agricultural workers, anti-haitianism, and health in the dominican republic. Human Organization, 69(1), 10-18. Retrieved from http://login.ezproxy.lib.umn.edu/login?url=https://search-proquest-com.ezp1.lib.umn.edu/docview/201175141?accountid=14586
- SPRING, & USAID. (2014, October 16). Household Hunger Scale. Retrieved from https://www.spring-nutrition.org/publications/tool-summaries/household-hunger-scale