The glory of a health care system free from government

I was visiting one of my project partners today.
She has two daughters, the youngest of them 6 years old. While we were talking the girl from next door, about the same age, came over to play with the daughter.
I couldn't help but notice the fresh dime-sized scabs and scars all over her lower legs. It was some sort of skin disease.

What is it from? No one knows. Has the mother seen a doctor about it? No. Why not? No tiene dinero.

It's as simple as that. This is the Dominican Republic. This is a third-world country. There is no real public health care system. It is almost totally private, and thus inaccessible to most of the population.

A short while later, my project partner pulled out a box and showed me what was inside. It was bandages and sanitary napkins.
They are for her brother. Last year he was a security guard at a bank when it was robbed. He was shot twice and nearly died. He was taken to a hospital who told them that there was no hope.
Then the hospital found out that he was injured on the job, and thus had health insurance.
Suddenly there was hope.

Many months later he's still in bad shape, but alive. However, the insurance doesn't cover everything. That's why my project partner is taking clean bandages and sanity napkins to his hospital.

Hospital care in this country varies entirely on the ability to pay.

I live about 100 yards away from a small, local hospital. I hadn't gone into it until two weeks ago, when the father of my host family contracted influenza.
He would up in the hospital, hooked up to an IV.

The day after he was admitted, his wife showed up at my door. She needed a bucket of water. Why? Because the hospital didn't have any water to bath him with.
Needless to say, the hospital also doesn't provide food. Families do that too.

My host family doesn't have health insurance.

As a Peace Corps volunteer, I have health insurance. Fortunately, I haven't had to use it so far (knock on wood).
One part of the training was a tour of a hospital in Santo Domingo that the Peace Corps uses. It was as clean and modern as any private hospital in the United States.
The Peace Corps uses this hospital (and one in Santiago) exclusively. I've been told that no matter how sick I am, they will not let me be admitted to any other hospital.

I have health insurance and Devil take the hindmost.

Little Haiti

I was talking with my brother the other day about the pathetic state of the local campo dog that wants me to be its owner. It has a badly injured foot that is beyond treatment. It needs to be put to sleep, but there is no vet within two hours of my Dominican pueblo.
He asked me what the locals do in such cases. Generally the dogs are poisoned or simply left to slowly die. Then I responded with my blackest humor: "Dogs here are treated almost as badly as Haitians."

You can always tell when you are in a Haitian neighbourhood in the Dominican Republic. Dirt floor shacks, naked children, and worst of all, the sense of hopelessness. Unlike Dominican children, Haitian children are typically shy and very cautious. It's Mississippi in the 1950's times 1,000.
It's not like the Dominicans are rich in comparison. They also live in houses with tin roofs and eat the same food. However, almost every Dominican I've talked to has warned me not to go into the Haitian neighbourhoods. Why? Because there are Haitians there. I've been told that Haitian have no concept of hygiene or respect for the environment.
But that is merely the start. A fellow Peace Corps volunteer and friend in the southern part of the country told me that when a Haitian tried to board a GuaGua he was on, all the Dominican in the bus demanded that he be kicked off. Several said the Haitian "fouled the air".

Dominicans have had an issue with Haiti for nearly two centuries. Independence Day wasn't the day that the Dominican Republic cast off the oppression of Spain (twice). It's when it drove the Haitians out in 1844. The hatred of Haitian immigrants was best exemplified by the insanity of The Parsley Massacre.
No nation is more hostile to Haiti and Haitian immigrants. What's more, things are getting worse.

I just got back from Dajabon today. It's a town on the Dominican/Haitian border. Every Monday and Friday there is a huge mercado.
I cannot describe the Haitian market and still do it justice. It has to be experienced, but I will try anyway.

Imagine, if you will, a blazing, hot sun and dusty, dirt roads. As far as the eye can see there are stalls where people are hawking their wares. There is no real pattern to how the stalls are arranged. Sometimes their goods are on tables. Sometimes just spread out on tarps on the ground. Sometimes tarps have been strung up to give a little bit of shade, but the ropes are so low that you have to be careful or they will hit you in the face as you walk.
The whole market is crowded beyond capacity. Every hundred feet or so you will need to physically push the people around you, or get pushed in the back. Every third person is someone hawking goods, traditionally by shoving them in your face. Just saying "no, gracias" or "no quiero" won't convince them to get the boxer shorts out of your face. Some of the stalls have people yelling prices into megaphones.
Meanwhile, there are motorcycles with faulty mufflers running through the crowds, often with huge bags of goods on the back. With only between five to ten feet between the stalls, that means the motorcycles literally have to knock people out of the way.
The smell of exhaust and pollution in the hot, dusty air is sickening and the sound is deafening.

So why would anyone go there? Because of the dirt, cheap prices on clothes. I'm currently wearing a pair of jeans that I bought for less than $3 and a t-shirt for about 70 cents. I don't know where the Haitians get their goods from, but they must get them for next to nothing.

The reason why I am talking about the trip is both because the Dajabon Haitian mercado is a fascinating place for the study of the third world, but also because of what happened while I was returning to my pueblo.
The GuaGua ride from Dajabon to Loma de Cabrerra is about 21 km. The thing is, Dajabon is a major human trafficking location, so the Dominican military has set up multiple check points on any road leaving Dajabon.

At the first military check point, the soldier looked in side door and openly threatened anyone who looked Haitian that they better have their passport with them, or else. There were about 12 people in the minivan (crowded by American standards, but not by Dominican standards). The Haitian-looking woman next to me didn't have her passport, and so got pulled off the GuaGua.
At the next military checkpoint only one person got asked for identification - me. The whitest, most American-looking person in the minivan (which means I'm the one most likely to have dinero). Obviously the soldier was hoping that I didn't have identification, because then I would have to bribe him (the bribe is widely known to be 100 pesos). Unfortunately for him, I remembered to bring it. As we drove away I loudly said, "Solo me" and all the Dominicans on the GuaGua burst out laughing.

A big problem in the Dominican Republic is people not being registered. The Peace Corps encourages every volunteer to help people get their birth certificate. Most people don't have them simply because getting one at birth costs money, and there isn't a lot of that around.
By not having a birth certificate a Dominican cannot vote, get a passport, or open a bank account. It is a huge hindrance.
But that is nothing compared to what Haitians face in the Dominican Republic.
As far the Dominican government is concerned if your parents were born in Haiti, then you are Haitian. This applies to people who have never been to Haiti. Thus the hundreds of thousands of children of people who fled oppression or violence in Haiti and were born in the Dominican Republic are children without a country.

Sonia Pierre, a Dominican human rights activist, says the changes in Dominican citizenship laws have made hundreds of thousands of Dominicans of Haitian descent, in effect, stateless. She points to a landmark international court decision in 2005 calling on the Dominican government to end its discrimination against this population. But the government did the opposite - it hardened its policies and began retroactively withdrawing citizenship from Dominicans of Haitian descent.
Claiming that it is only trying to "clean up" its civil registry rolls, the government now systematically refuses to issue identity documents to Dominicans of Haitian descent. Officials often deny these documents because someone has a Haitian-sounding last name or "looks" Haitian.
Sonia Pierre's organisation, the Movement of Dominican-Haitian Women (MUDHA), has documented thousands of cases where the government is systematically denying rights to Dominicans of Haitian ancestry. Those affected come from all walks of life - schoolteachers, lawyers, community organisers, doctors, entertainers, caregivers, students, and military officers. Now these people are in danger of becoming stateless in the country of their birth and residency.
Many are facing deportation to Haiti or a life outside the law. "If I don't have my ID and I'm walking down the street, immigration may grab and deport me like they do with many Haitians," says Daniela Siri Yan, a vivacious 18-year-old who studied computer science at the local high school.

I've already made the decision that this isn't a battle that I'm going to fight, because I can't win it. If I fight for the Haitians then I will lose the Dominicans in my community, and they already need more help than I can give.
At the same time, it's hard to see the discrimination every day and not have it tear at your heart.