Initial Wrap-up

Hello!

As January (somehow) winds down, I wanted to take this time to give you a (relatively) short wrap-up of the work that HHI's Public Health Team recently completed in the Dominican Republic. Please feel free to forward to whomever you feel may be interested, be they family, friends, donors, or anyone else! We are all now back stateside, and diving into our classes, and also be putting together an analysis of our findings, so as to improve HHI's diabetes and hypertension prevention techniques. Hope you enjoy!

Last Saturday (1/7), Health Horizons International's Public Health Team departed the cold US for the warmth of the North Coast of the Dominican Republic. After journeying on planes, trains, and automobiles, all eleven team members made it safely, and on-time to Puerto Plata, well-rested from the holidays and prepared to execute the Community-Based Participatory Research project we had planned over the fall semester.

In accordance with HHI's mission to build capacity for achieving community health, we designed a project in which community members would use PhotoVoice to document the attitudes and behaviors they felt influenced hypertension and diabetes. PhotoVoice provides individuals with cameras, gives them a theme on which to focus, and finally engages them in focus group discussions with the other participants. The end goal of this technique is to facilitate the flow of ideas and empower the participants to work for change. In this case, by focusing on hypertension and diabetes, participants not only aggregated their own ideas on the diseases, but also provides HHI with formative input for its soon-to-be rolled out Healthy Lifestyle Intervention. Thus, the communities of Severet and Pancho Mateo, HHI itself, and the partnership between them, will each be empowered to stem the growing tide of diabetes and hypertension.

The project got off to a great start in both communities, as each community produced more than our target number of participants, and their enthusiasm for the project was palpable. After a first day of discussion about the most effective and ethical ways to take photographs, how the weeklong project would work, and the consent process, the participant groups of each community set off to fulfill their first photography "assignment," documenting the important aspects of their daily lives. This broad theme served as an introduction to the project, through which we could troubleshoot issues and further develop ideas, while still gaining valuable information about the lifestyle in each community.

Unfortunately, the project turned stressful as we attempted to upload and discuss each participant's photos. In order to properly discuss photos as a group, we would need to display them on a larger screen, so uploading to a computer was imperative. Despite my testing of several of the cameras before we left the US, bugs in the camera programming plagued uploading. Many cameras uploaded the pictures as plain white, others would not upload at all, and we later discovered that removing the batteries from the camera erased the entire memory card. Although frustrated with the lack of functionality of the cameras, the Public Health Team waxed creative, began taking pictures of the participants' images as they appeared on the view screen of each malfunctioning camera. The quality of each photo suffered slightly, but we were still able to use the photos for discussion purposes. A lesson about reliance on technology was quickly learned by all.

With this adaptation, each community proceeded to the second assignment, which focused participants' photos on all environments, behaviors, actions, people, and things that either prevent or promote hypertension or diabetes. After allowing the participants to take such photos, we held several focus groups to discuss what they had found. Many interesting findings surfaced, and we will be releasing a full write-up in the coming weeks to summarize them. The statements of community members, concerning both what is not known or misconstrued, but also that which health-promoting knowledge already exists, will surely be profoundly formative to the content and mechanisms of HHI's Healthy Lifestyle initiative.

On the final day of the project, community members created a poster and presented their findings to their fellow community members, and succeeded in stirring up demands for change, especially in Pancho Mateo. Throughout the week, we had seen, as we had hoped, that the project's critical thinking exercises had provided participants with a new sense of what the community's problems were, and what they could do about them. During this final presentation, that progressive energy truly came to the surface, and participants delivered rousing messages about improving quality of life. Community members called for the community itself to take action, given the support that HHI had provided them. This outcome is one of the most important of all; once the community itself is motivated to create progressive change, the work of NGOs becomes facilitated, and partnerships between the two parties function more smoothly and effectively. The empowerment of the presentation was a triumphant note on which to end the project, and each community and its facilitators celebrated with a spectacular, home-cooked lunch. After a few laughs and universally full stomachs, the Public Health Team parted ways with each of the communities. We spent a few hours relaxing on the beach, recuperating slightly before our respective homeward journeys.

Stay on the lookout for future updates from us as we analyze the results of the project. Please feel free to email me with any questions or comments!

Sincerely Yours,

Erik

Bryn's Follow-Up

The days have been filled with work and play and a new culture that I never in the least bit expected. Pancho Mateo is a place of community, culture, and a sense of belonging. Even through the adversity of racism (and, believe me, it exists in a very significant way here) and relative poverty, contentment exists in human interaction and love. It’s a bit overwhelming to feel so at peace and so content in a world where so many things-literally “things”- that we often hold too close to our hearts do not exist. Why worry yourself when you have family, food, and the laughter that pleasantly echoes from every doorway? Here, houses are open, space is shared, and every adult scolds, feeds, and brags about every others’ children. I am humbled by the peace with which people carry out their lives when I myself rely on much more for my happiness.

Yesterday, after captioning photos for our project with our participants and newfound friends, we all went to play soccer in the park. To us, the park in Pancho looked like a mere concrete slab with two basketball hoops and a set of stands, but I have never seen a park in American used as much or as well as this. Needless to say, the game served as a reminder of the importance of proper footwear and clothing during athletics. Then again, my long skirt and rain boots seemed an acceptable choice after noting that several little boys in flip-flops and jeans were schooling me. Not many older girls still play sports with the boys, so it brought a lot of smiles and laughter from the group of kids that eventually caught wind of a game going on. Sure enough, there were soon two basketball games, a dance competition, and a girl riding around on her bicycle, on top of our game, leaving the court scattered with competitors. No one complained, however; this is space for everyone to share. When we grew tired and sat down to watch the scene, it was enough to just rest and chat about life and our similarities and hilarious differences.

Places like Pancho Mateo remind you of how much there is to be joyous about in life. Sometimes having more things is a distraction from the things that matter most. To this community, there cherish what they have. Although they are grateful for more, they do not seem to perpetually seek it as I often do. This is something I hope to take with me when I land on American soil.

P.S. My Spanish is believable when I say hello and goodbye now! What a miracle!

We are tired, yet satisfied, here in the Dominican Republic. Our team is hard at work setting up PhotoVoice assignments, captioning photos, gathering data on community opinions and priorities, overcoming the technical difficulties inherent with $20 digital cameras, and building rapport with community members. Tomorrow brings our most important venture: a day of large and small focus groups with the participants, in order to flesh out what the community members beliefs and behaviors are, with respect to the all-to-prevalent diseases: hypertension (aqui se dicen “la presion,” literally, pressure) and diabetes (se dicen “el azucar,” literally, sugar.). HHI has been working continually toward the second tenet of its mission statement, building capacity for community health, by initiating efforts to prevent the chronic diseases with which its thrice-yearly medical clinics must deal with so frequently. Tracy Kaye, HHI’s new public health director, is building a healthy lifestyle initiative to address this, and with the help of our research, the intervention will become aligned with the goals, opinions, and needs of the communities with whom HHI has partnered. Already, in the captioning process, some critical information has surfaced. Understandably, we are bubbling with excitement to dive headlong into the wealth of information that these community members hold. There is more to come from the Public Health Team; I will try not to build up the suspense too much. Best wishes from the DR!

Erik

Erik's Point of View

It is both rejuvenating and sobering to be back in Puerto Plata, Dominican Republic. After a 2:30AM wake up for a long day of traveling, and two days of logistical prep work for this week’s PhotoVoice (FotoVoz) project, I finally have some time to sit and reflect. This year, I am working in Severet, a different HHI partner community from the one in which I did research last year. Severet is more rural, less densely populated, and a bit more tranquil, perhaps due to its remoteness. Today we met and worked with the participants so that they could be as effective as possible in documenting their lives through the use of photography. Despite a few last minute hiccups, the discussions and trainings went off without any issues, which has filled me with a unique sense of excitement and success. The community members themselves showed an outstanding enthusiasm to participate and to work toward a better future for their communities, an enthusiasm that, with the proper support, resources, cooperation, and respect, will be the engine of change over time. I think I can speak for the group, and I most certainly can say for myself, that beyond any doubt, the fall semester’s energy and diligence has resurfaced and redoubled here on the north coast of the DR. Tomorrow’s work can’t come soon enough.

Many of the same problems persist in Pancho Mateo, but new developments, both literally and culturally, have appeared. Chronic disease, water, income, food, and other major structural issues continue to plague the community, but additionally, a new housing development has sprung up in what was once a vacant field in Pancho Mateo. The apartment complex is mysterious; no one from the government or a contracting company has come to literally next-door Pancho Mateo to explain the development. Thus rumors and conjectures have sprung up. Perhaps the government is using it to buy votes for the upcoming election. Perhaps it is an affordable housing project. Perhaps it is meant to serve as temporary housing for those displaced by floods or other dangers. No one knows for sure, and everyone is looking for answers. On a massively positive note, Willy (an old friend from last year’s trip), and several other young (late teens, early 20’s) have formed a work group to advocate for and acquire access to clean water for Pancho Mateo. Their plan is well thought out, based in research and facts, and best of all, is motivated by a desire to improve life in the community. I thought to myself, “this is the community-driven action that development NGOs dream about” as Willy explained the steps of the plan, their progress, and how they are unwavering in enacting change, and employing their strength, creativity, connectedness, and drive for the good of Pancho Mateo. More to come from all fronts, and from the group members themselves. 

-- Erik

A Letter From Bryn

It’s an amazing thing to travel, to enter a world in which unknown becomes normal and unimaginable becomes reality. After two days among the locals of Pancho Mateo and Severet, my normal has become my long conservative skirt, “botas” (rain boots) to avoid excessive and constant mud, and the persistent existence of sweat on my brow. Dominican weather is anything but dry, and I can only imagine living in a summer with a heat index of around 120 degrees.

So what is it like, you ask? When we stepped off of the truck on our first day in Pancho Mateo, a hoard of young girls with braided hair and flawless complexions came running to grab our hands and tug on our skirts. Perhaps this is because they expect gifts from international travelers; perhaps they are excited by the mysteriousness of a different world. Because I can say a total of about 10 words in Spanish, the best form of communication with these adorable children is hand squeezes and mutual funny faces.  We were greeted by a group of young men and a few women, all around our age, one of which is the Community Health Worker of Pancho Mateo, Willy, hired by HHI to lead health initiatives in his community and aid those in need. It is one thing to join in an already established health initiative. It is another thing to initiate health promotion in your community, especially as a young adult. It is inspiring to say the least. I am reminded of the amount of times I have hesitated in community health promotion solely because the existing capacity and resources seems too limited; my observations in Pancho Mateo have already begun to challenge those hesitations.

What continues to amaze me are the many normalities that penetrate the cultural, economic, geographical barriers that I assume exist in the world.  Young girls spend hours braiding each others’ hair, men gather together to play games and drink beer, and young adults enjoy dancing, music, and-of course- facebook. Commonalities reside in even the farthest reaches of the world (and the DR is surprisingly close), and traveling is a constant reminder that human interaction is natural and important to promote a better understanding of our nature. This is only day three, and my mind is reeling. I will have more to report later; I can’t wait to see what new experiences lie ahead.

In closing, two things I already miss: casual afternoon runs (we have been waking up at 7 am to run here) and being able to flush toilet paper.

ADIOS!!!!!! MUCHO AMOR!!! 

-- Bryn

We're Here

Hello to our (concerned) friends and family! We're safe, if a little bit muddy and very tired. It's raining here in the DR, which is common for this time of year. We finally figured out Internet access at the hotel, and we've all had a chance to sit down and write about our experience so far. It was our first day doing our public health project using photovoice today, and we've all got a lot to say. Here are some initial reactions from group members. We'll be adding more later too, so stay tuned.

• This was my second year returning to Pancho Mateo. A lot changed over the past 12 months, but a lot stayed the same. A new housing complex replaced a field that bordered the community, but whether or not Pancho Mateo-ans will inhabit them remains a mystery. Additionally, youth have banded together to strategize how to improve water access. Despite these changes, much of community life appears the same. The community is still pulsing with chatter, music, and shouts from children, but residents still face challenges. The streets are muddy, the highway is rocky, children are without opportunities for education, and residents are anxious for change. Starting off this week so am I.

• Puerto Plata has been quite the trip thus far. Yesterday was an emotional roller coaster ride at points – going into the communities we’re working with for the first time and extreme sleep deprivation were probably the catalysts behind that – but today was a bit calmer on the feelings front and much more focused on getting down to business. Participants in Pancho Mateo and Severet were jazzed to take part in our project, and it seems like we’ve all found their excitement to be contagious. Language barriers aside (unfortunately they still exist even with the presence of Afsheen, one of our own who speaks anywhere from five to fifty languages) we seem to connect in both our goals and expectations for the week, and I’m stoked to see what comes from it.
  
• Afsheen -- There are revolutionary ideas afoot in Pancho Mateo. The youth gather around us as we enter the colorful patchwork of steel and wood shacks that compose this mixed Dominican-Haitian village tucked away in the mountainous hinterland of northern DR. The bright-eyed little ones grab for our hands, eager to share with us our contagious excitement with the whole affair, while the young adults address us in English, Spanish, and Haitian Creole in their most presentable attire. The youth of Pancho Mateo have not only become intimately involved with the work done by HHI in their bateye, but have taken a proactive role in drafting demands and social works projects to be implemented in the foreseeable future. George, a 29-year old Haitian, discusses the adverse consequences of the high birth rate and lack of resources that plague the sustainability of the new generation as we walk by the soccer field by the river. He is troubled by the images of naked children and muddy roads and free-roaming livestock that define the livelihood of the town today. Despite the fact that he is an illegal inhabitant on land owned by the bank in a country that actively discriminates against his kind, he is determined to participate in the newfound zeitgeist of his fellow young pioneers in Pancho Mateo. I believe this energy will be auspicious and instrumental for the follow-up of our project and in ultimately reaping the benefits of basic human services in their host country.

Mary C.'s Perspective on Severt, DR

It’s my third day in the DR without a cell phone. Time is weird here. There’s actually no real sense of time because clocks are not seen in hotel rooms nor in the lobby. People are not stressed about meeting up on time because anytime is good time, it seems.

Even though people do not stress so much about time, we still have to get work done on schedule. This morning, we had a long discussion about how to run our photo voice project in the community. It took longer than I thought and there were definitely a lot of details to think through. It was the first time that community members are in possession of cameras, so we had to share with them how to become responsible photographers. The question we came up with was “when would you not like people taking photos of you?” Another concern was that people might use cameras to take photos of their relatives. We spent time telling them that every photo they took had to mean something to them or to the community.

The most exciting part of today was holding the meeting at Severet, one of the communities that HH work with. The twelve Tufts volunteers were divided into two groups, one in Pancho Mateo and another in Severet, which is further away from the hotel. The truck ride was bumpy on the muddy road.  There were many puddles on the way and at one point we thought we had to push the truck. Luckily, we didn’t! Even though it was a long ride, I enjoyed the sceneries along the road. There were cows, sugarcane fields, and mountains. One kid chased our truck and got on the car with us for a few minutes before he decided to jump off the truck. 

When we finally arrived at the community, our volunteers were waiting at the church. All of them were women. I was paired with a grandmother. It was very nice getting to know her. She is not literate, so I read the photo voice consent form to her to make the information as transparent as possible for her. She was a little quiet but when I asked her about her family, her eyes would brighten up. Before we went home, she introduced me to two of her baby grandchildren. She is a great grandmother too! What I love most about today was being able to connect with people through their spoken language. I can’t wait to hear more about their stories from her photos tomorrow!