A Week in a Rural Dominican Clinic- Monte Llano
After an exciting weekend getting to know the small town of Monte Llano and its inhabitants, I couldn't imagine that our experience could get any more exciting. But every day met us with a new twist. Monday was our first day in the clinic, shadowing Jahaira, a young doctor 6 months into her mandatory year of work at the rural clinic. Our experience in the clinic was really interesting. Most of the patients who came in were coming for medicine to cure la gripe (the flu), but what I learned at the clinic was much more complex than the type of medication prescribed to lessen flu-like symptoms. I got a first-hand view of the Dominican healthcare system, which has some good elements and some setbacks. With a social security card, which most people seem to have, all the medicine and services at the clinic are free. When the doctors don't have the resources to treat a patient, the patient is referred to a specialist in the nearest hospital. The service in the public hospital in Salcedo is also free, but transportation down there from the village is pricey and time-consuming. In addition, I heard stories about poor care in Salcedo due to overcrowding of the public hospital. We saw cases of Tuberculosis, infections, asthma, body pain, and injuries from motorcycle accidents. Many villagers came in with hypertension due to the diet and lifestyle in the town. Though medication for high blood pressure is also free at the clinic, many people don't take their pills because they don't understand why it's important due to a lack of education. Kritheeka and I did a charla (lesson) for patients at the clinic on Thursday focusing on Hypertension because it was the most prevalent chronic disease in Monte Llano and the surrounding villages.
We also saw a lot of very young mothers and pregnant women. In Monte Llano, it is common for women to get pregnant at age 15 or 16, with girls as young as 12 or 13 having babies and getting married (there is no legal age minimum for marriage here). This is very much part of the culture, and one of the things that have been hardest for me to understand, much less accept. Kritheeka and I (age 21 and 20) thought it was funny that people were surprised that we are unmarried and don't have kids. Then our young friends in the village explained that it is common for young teens to get married here and have babies. Surprisingly, this is not due to a lack of access to birth control; the clinic gives out birth control for free, funded by the government. This was even more surprising to me in such a catholic country! Again, there is a lack of education about birth control, and condoms are readily available but rarely used. The role of women in this country has been one of the hardest things for me to deal with in the D.R., both from my own experiences here and hearing stories of Dominican women's lives. When I asked Jahaira if she thought people believe that men and women are equal, she said yes, but that people here believe a woman's role is taking care of kids, cooking, and doing housework while the man is supposed to provide for the family. I guess it comes down to having a different definition of equality, and a different idea of gender roles based on the culture you grew up in. The problem of education in these towns is also significant; there is no high school near the town at all, and many of the inhabitants have very little education. When women get pregnant at a young age, they take care of their kids instead of continuing their education. Only the few villagers who have family members in cities are able to move to continue their studies.
A lot of what I learned in Monte Llano was not specifically about medicine, but about cultural norms, socioeconomic inequity, racism, sexism, and poverty. I think we got a clearer image of Dominican culture in the small town because there are less outside influences than in Santiago. Although some of these experiences were troubling, I was surprised by how much I loved the small town atmosphere, detachment from technology, surprise visits from friends, and the emphasis on spending time with people instead of always trying to get the next thing done.