Tuesday, July 22, 2014

Barrio Lindo: Si me pegas, no me quieres (Tuesday Week 7)

"If you hit me, you don't love me"

The days are flying by faster and faster as the end draws closer.

On our first day back in class after returning from Salcedo, we went to Juan XXIII, a secondary level health center, to start our urban community outreach projects. We were divided into groups of two or three and assigned a neighborhood and a promotora or community health promoter to work with. I was extremely happy with my group, and Esperanza, our promotora. As we were trying to decide on a topic, Esperanza asked us what our interests were. I said chronic diseases, and my two partners said women's health and children's health. We all looked at each other for a minute, since our responses were all so different, and then Esperanza suggested domestic violence as a topic. We all agreed it was perfect--it's a complex chronic issue that impacts women and families, and it's a significant problem in the community.

Barrio Lindo
After choosing a topic, we left Juan XXIII and went out to visit our barrio. We are working in Barrio Lindo, which is a poorer neighborhood, but not terrible by Dominican standards. Like the rural town of El Coco, the community is very close-knit. Everyone calls out greetings as we walk around and the promotoras know almost everyone by name. It's a much different feel from the upper-class neighborhoods where we live, where all of the houses have high wall and gates and the streets are almost deserted during the day.

For our project, we decided to conduct interviews in the community about the prevalence of and attitudes toward domestic violence, and then incorporate our findings into a charla to be given at the local community center. We wrote up a list of seven questions, then headed out into the community to do the interviews. We recruited the help of two other promotoras (Dolores and Yanesli) so that we could split up into three groups and get more interviews done. This was good for efficiency, but also made me a little nervous since I couldn't rely on my more outspoken group members to do the talking. I was with Esperanza, and she was very encouraging and let me do the interviews mostly on my own. She gave me help when I needed it, but only when I needed it. The experience definitely pushed me outside my comfort zone and the responses were really fascinating.

My group member Bellanira doing an interview
Twenty-nine out of 38 people agreed that domestic violence was common in the community. Nationally, 24% of all Dominican women between the ages of 15 and 49 experienced physical aggression from a romantic partner or family member. The people we interviewed cited all sorts of things as causes of violence, including jealousy, alcohol and drugs, lack of love, respect and communication. Multiple people also brought up lack of employment, because the lack of money puts stress on the relationship and because partners lack constructive ways to occupy the time so they end up arguing.

I found this answer especially interesting because, from an American perspective, I've noticed that Dominicans of all ages spend lots of time hanging out and just passing the time, even on weekdays during working hours. Part of the reason for this is a lack of jobs, especially full-time formal jobs, but a lot of it just is the Caribbean culture. It's a little less obvious among upper/middle class Dominicans, who tend to work 9 to 5, but I think the gulf between my American need to accomplish things and the Dominican "Cógelo suave" (Take it easy) attitude would be difficult to bridge, even if I were to live here for a long time. Anyway, because I know my impatience with all of the "hanging out" is a cultural difference, I wasn't expecting to hear people acknowledge it as a cause of violence, but they did. Of course, acknowledging a problem and figuring out how to solve it are two different things entirely, but everything has to start somewhere.

The interviews also revealed some things about gender relations in the community, where  machismo has a very strong influence. There are efforts to change that, but progress is slow, especially among lower class people. Some people said disobedience on the women's part causes of violence, and many people emphasized that violence was the "not only the man's fault" or "the women's fault too." Although it's true that both parties can contribute to a conflict, it sounded like the community might tend to blame a victim instead of supporting her. A lot of people knew of resources for victims of domestic violence, but many people also brought up fear of retaliation from the abuser if the victim tried to get help. It's a serious fear--unfortunately there are reports of women being murdered on almost a weekly basis.
Giving the charla!
On Monday, we presented our findings in a charla in the local community center. We invited all of the people that we interviewed to the charla, but very few of them came. We were starting to get worried when some of the neighborhood kids wandered in. The promotoras convinced them to stay and listen, and suddenly the room was full with about 30 kids from ages 4 to 15, plus a handful of adults mixed in. We had to change the tone of our presentation a little, since we had prepared for an adult audience, but we were able to improvise and got a lot of audience participation. I was surprised by how successful it was and how much fun I had doing it, and I'm excited to present our project in my Community Medicine class on Thursday.

Our charla was well-attended!
Overall, our project in Barrio Lindo has been one of my favorite parts of the program, because I get to see public health theory turn into practice. In my global health classes at Pitt we talked about the importance of "community health workers" and "knowledge, attitudes and practices surveys" but I had no idea what the terms really meant in practice. Now I know, and I'm even more convinced of how effective promotoras can be and how vital they are to public health. Each primary health care center in the DR is supposed to have two paid promotoras, but unfortunately many centers don't have the funds--Barrio Lindo is one of the lucky ones (Yanelsi, the third promotora, is a volunteer). It's very inspiring to see how well Esperanza and Dolores know the community and how much they care about improving it, and I'm grateful that they so graciously and generously took the time to work with us. Even though our project was pretty small and insignificant, it's nice to know that Dolores and Esperanza do this kind of work every day and over time it has a big impact on the community.

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