CULTURE AND GLOBAL HEALTH
Gain a better understanding of the culture and recieve medical insight
of life in the Dominican Republic.
of life in the Dominican Republic.
The first theme, family presence is essential for meaningful care experiences and care practices, indicates it is essential for families to be present, for care to be optimal. Rural Dominicans clearly articulated the meaning of culturally congruent care to include family presence for a person experiencing illness “Family is everything. It is the most important and central thing to this culture. When the family is together and very close, this is beautiful! Life is lived for the family and it is a blessing when the whole family is together. We make decisions by consulting family members, close and extended. Family is the basis of our society. Family is central to everything all over this country” In rural Dominican culture, the concept of family extends to neighbors, friends, and all who make up the community of which they are part. “keeping an ill person’s family away” hindered care that is culturally congruent. Caregivers may need to accommodate and negotiate family involvement in care situations that may have prohibitions that conflict with accommodating family involvement The second identified theme, respect and attention are central to the meaning of care for rural Dominicans. Showing respect and offering one’s attention as the best way to express care to another individual. This includes taking someone’s thoughts, feelings, needs, wishes, and ideas into consideration. When approaching a Dominican with attitudes and actions that convey respect and attention, the person perceives a sense of value and worth and ultimately, “cared for.” Caregivers need to show respect to Dominican patients by sitting, listening, and spending time with them when possible, remembering that lack of time and attention may be perceived as lack of care. · Caregivers should show respect by asking questions and pursuing a Dominican client’s thoughts and concerns. · Caregivers should make attempts to notice and offer comment to what seems to be important to the Dominican patient. · Caregivers should offer undivided attention or selective concentration to a Dominican patient when possible and focus deliberate, patient-centered, mental and physical concentration to the person in need. Sitting and facing a Dominican patient, making eye contact, and tuning out unrelated stimuli are culturally congruent. Sub theme Machisimo: The Latin Caribbean doctrine of machisimo, male dominance present in the DR but is most frequently described negatively and specifically meant men having many women or two or more families. It is considered a distructive attribute for the health and wellbeing of the village. Dominican machistas (pleural) are considered disrespectful to spouses and children and perceived as uncaring. “Machisimo affects children. They think dad is leaving and he is not going to love me anymore. Their grades are affected . . . my father is not good because he is with women all the time and cannot provide for me or my sister due to all of his children.” Besides limiting economic opportunities for health and education services, there also existed a prominent fear of HIV and sexually transmitted diseases (STDs) among informants because of the nature and practices of Dominican machistas. The island of Hispaniola (which contains both Haiti on its west and the DR on its east) is documented as having the highest Caribbean concentration of HIV (Caribbean Aids Epidemic Update, 2006), and villagers described a significant fear of transmission from the sexual practices of machista men. The third theme, rural Dominicans both value and use generic (folk) and professional care practices. Lines are ambiguous between professional, generic, spiritual, and remedy-based care practices, and many Dominicans employed a variety of practices that were derived from each of these categories. There was no clear pattern or sequence as to when Dominicans chose to use alternative versus traditional practice. See attached Document for more examples |
Global Burden of DiseaseThere is a wide variety of complaints and symptoms shared in the clinics. This list is what our group typically sees. Common complaints were as follows:
Haiti has the highest rate of HIV/AIDS in the carribean. Together with the Dominican republic they account for three quarters of the cases. HIV/AIDS is the leading cause of infectious mortality in adults and children in Haiti. TB is the second leading cause of infectious mortality in adults and children in Haiti. Fertility rate for women Dominican 2.83: Haitian 4.79:1
Major infectious diseases in the country are: Vector borne: malaria, lymphatic filariasis, and dengue fever Food/water borne: Hepatitis A, B, E, and C; typhoid fever, and leptospirosis.
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Social and Economic Determinates of Health
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Population Resources and EnvironmentPopulation of Dominican republic (UN estimate 2017) 10,769,020 Retreived from http://www.worldometers.info/world-population/dominican-republic-population/
Population of Haitians living in Dominican Republic (2012) 650,000-1 million (estimate vary widely). Since 2010 the Dominican Republic has deported Haitians at a net rate to decrease the Haitian population by 30,000 each year. Ethnic makeup of population: Dominican mixed European and African Descent (population emphasizes their European heritage)Haitian mostly African heritage The health system in the Dominican Republic is a mixture of public and private (for profit and not for profit) services. Within the public sector care is free but with no guarantee of access. What is a Batey? Families live in poverty in the bateyes of the Dominican Republic. A Haitian batey (pronounced BAH-tay) (plural bateyes) is a shanty-town camp where sugarcane cutters live. Bateyes are found only in Cuba and the Dominican Republic.On the surface, Haitian bateyes appear very similar to poor Dominican villages. To understand the real differences, one must understand how and why bateyes came into existence. https://cotni.org/news/dominican-republic/2007/11/14/origin-dominican-batey# |
Globalization of Healthcare
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Healthcare in Resource Poor Settings
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