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Considering that we have been involved in Paraiso since 2006, people periodically ask us why we have not yet established anything more permanent in the community. The reason that this process has taken as long as it has is because we are so deeply committed to working in partnership with the community. One of our key beliefs is that any intervention in the community should have the community’s active assent and participation. Otherwise, we run the risk of spending great time and effort with little to show for it.
An example of what can go wrong: at a different site (in northern Nicaragua), a large non-governmental organzation (NGO) determined that access to safe drinking water was a key need for the community. The NGO held a community meeting and got their approval, and proceeded to spend a great deal of time and money digging wells in the community to provide drinking water. The outcome a few years later: some wells are still working and providing water to the community as intended. Some wells are broken and non-functional and the community is unable to repair them. Some wells are on private property and the general community has been locked out–the well dug by the NGO is being used by certain people and denied to others.
As a non-profit organization, we are given great trust and responsibility–both by the community where we work and our donors and supporters. We are entrusted to make the most out of the resources available and to make a lasting difference in the community. If we try to impose our ideas without adequately involving the community, we run great risk of replicating the Nicaragua NGO’s errors: spending valaube resources for little benefit.
Our approach is time-consuming and requires great trust and commitment between us and the community. Howver, this level of involvement and engagement is what we feel will make the greatest lasting difference in Paraiso. As we grow, we would endeavor to keep this same level of commitment to other communities in the Dominican Republic.
In April 2006, a thoughtful 2nd year medical student from Yale named Maya Roberts wrote an opinion article published in the Journal of the American Medical Association (JAMA) titled “Duffle Bag Medicine”. This article criticized many short-term medical relief trips that worked in communities with little regard to those communities’ residents. Many of these trips included non-medical volunteers acting in medical roles and the individual groups often had no long-term commitment to the community and lacked even the basic language skills to communicate with the residents.
Ms. Roberts (presumably now Dr. Roberts) pointed out that this approach to medical care would be unacceptable in the United States: poorly trained or untrained volunteers, inability to communicate effectively with a community’s residents, and lack of long-term connection with the community in question lead to unhappy and potentially dangerous results. At best, the medical relief trips may make little difference in the community members’ health and well being. At worst, the trips drain resources that could have been better used elsewhere and run the risk of causing harm or disruption in the community they intend to serve.
This is a great concern of ours. We do not want to fall into the “Duffle Bag Medicine” trap. We have sought a deep and ongoing engagement with the community of Paraiso. We have sought the community’s input throughout the project, and have developed a strong relationship with the community’s leaders: both official and unofficial. We have used a community-oriented focus throughout the medical efforts in the community. Untrained volunteers are not responsible for medical care, but rather work in support roles in the clinic and in community organzation and community development projects.
We recognize that the danger of causing inadvertent harm to the community is very high, and we realize that valuable resources are being used in our efforts in the Dominican Republic. We have sought to be responsible to all of our stakeholders–the community, the providers and other participants, and our supporters–to do right by all of them.
Our eventual goal is to help the community identify the issues that underlie the health of the community (water access, nutrition, etc) and to work with the community members as they develop their own responses to these issues. At the same time, we hope to enhance the medical care we can provide in Paraiso.
We are not providing duffel bag care. We are working with a community-oriented focus and have as a goal a stronger community which is able to address its own concerns and issues in the future–both at the community and medical levels.
(If interested, the JAMA citation is: JAMA 2006; 295(13): 1491-1492)
During this time, we provided medical evaluations to nearly 650 patients, both in the school-based clinic and through roving medical outreach teams. Of these patients, 118 (nearly 20%) of them had medical problems severe enough that we will attempt to provide follow up care during our next trip. These medical problems included diabetes, asthma and high blood pressure as well as more urgent short-term problems such as infections.
Our volunteers paid for their own travel, lodging and food costs. The organization was responsible for medicines and necessary medical and office supplies. Considering this, these patients were seen at a cost to the Dominican Aid Society of $3.84 per person.
In future posts, we will describe the current project in more detail in order to give you a better idea of the organization’s current efforts.