22 April, 2006
Since 2003, the Batey Relief Alliance, through its regional arm inside the Dominican Republic, the BRA Dominicana, delivered permanent health and HIV/AIDS care and social services inside the bateyes of the Dominican Republic through its 30-foot, fully-equipped mobile clinic (stationed at batey Cojobal) and a network of community-based health promoters. BRA’s health services are highly concentrated in the province of Monte Plata – but also expand into the border areas of Haiti through various local partner non-government organizations (NGOs) and government agencies.
Batey (ba-tay) is the Taino Indian word used in pre-Columbus era for a village attached to sugar cane plantations. The Dominican Republic continues to use the term into the 21st century as State-owned rural sugar plantations designed to house Haitian migrant sugar cane cutters and their descendents. Today, most of the Dominican’s sugar mills have been closed leaving tens of thousands in the batey(es) unemployed and in horrific living conditions. There is often no water, latrines, electricity or garbage collection. Access to healthy food, medicine, medical care, and employment is extremely limited, while malnutrition and disease are rampant. People in the bateyes must bear the additional burden of discrimination and fear of deportation to Haiti—a result of the deep-seated anti-Haitianism that has persisted in the Dominican Republic for years. Generations of Dominican children born of undocumented Haitian parents are prohibited by the State from obtaining a birth certificate making it difficult to attend school. The marginalization coupled with extreme poverty makes it difficult, if not impossible, for batey residents to access health services outside of their communities.
Haiti and the Dominican Republic combined account for more than 75% of all HIV cases in the Caribbean region – and the second highest to sub-Saharan Africa. Migration on the island of Hispaniola between Haiti and the Dominican is highly politicized and often under regulated. The people living in the bateyes are among the most affected by HIV/AIDS in the Western Hemisphere. A recent study found that 8.8%, or approximately 1 in 11, of women in the bateyes are HIV-positive, as compared to a prevalence of 1.25% among low-income women in the Dominican Republic. This has already had a devastating impact on these communities, leaving behind orphans who may or may not be infected, as well as unstable family units.
The issues surrounding HIV/AIDS in the bateyes are complex; they are impacted by social-economic and political structures such as unemployment, migration, discrimination, stigma, and gender inequality that require solutions that reach beyond the boundaries of health care. BRA’s insight into the broader, structural issues, along with its humanitarian mission to provide health care as well as social services inside the bateyes, underlies its HIV/AIDS intervention.
BRA’s community-based approach to health and HIV care starts with organizing and training 127 volunteer health promoters who work in over 32 batey communities. The promoters, who are members of the communities, provide culturally-oriented education and counseling on HIV/AIDS, including prevention of vertical transmission, and health wellness issues – and referrals to BRA’s health services in a community of over 200,000 people. At the mobile clinic, teams of health professionals (foreign volunteers and local providers) deliver primary care, essential medicines, and preventative health services to residents including the special services of optometry, gynecology, and HIV/AIDS and Tuberculosis.
Beginning in 2004, BRA brought additional resources to HIV-positive people in the bateyes. It offers free health care to AIDS patients inside their own communities including treatment for opportunistic infections and HIV counseling and testing at its mobile clinic; facilitates transportation to sites where specialized care, CD4 tests and antiretroviral drugs are available; and assists patients with nutrition and hygiene. The children too receive medical care and medicine, nutrition and clothing, hygiene and dental education and treatment, and toys.
Through a two-year long project funded by USAID/Family Health International, BRA is commissioned, under the “Rainbow” HIV/AIDS prevention program, to identify and provide care to 1,700 people: 100 pregnant women, 200 people living with HIV/AIDS, 1,000 children, orphans and vulnerable individuals, and 400 affected individuals living with HIV patients. The program also teaches about HIV/AIDS prevention and treatment in schools and churches, unite individuals affected by HIV/AIDS through workshops for and home visit to patients and their families, and provide vocational training to people living with HIV/AIDS.
With the support of the Dominican Ministry of Health/DIGECITTS, the William J. Clinton Foundation, and the Columbia University Mailman School of Public Health, BRA will soon be expanding the services available to HIV/AIDS patients at its new health center at batey Cinco Casas. The health center, uniquely positioned to serve the people of the bateyes from inside the communities themselves, will be offering a cadre of medical and psychosocial services especially for HIV/AIDS including, for the first time to batey AIDS sufferers, antiretroviral treatment.
BRA has already made great strides in providing batey-based solutions to address the health and HIV/AIDS care needs of these marginalized communities. In order to continue serving this population, BRA necessitates continued awareness and support for its mission. For more information about BRA’s HIV/AIDS program inside the bateyes, visit www.bateyrelief.org.
By Morgan Chessia & Chitra Akileswaran
Graduates of Brown University
BRA’s volunteers on HIV/AIDS matters – 2006-2007
BRA’s Mobile Health Clinic
Batey Cojobal, Province of Monte Plata
© Batey Relief Alliance 2006
