05 January, 2006
“…The Batey Relief Alliance is doing important and difficult work. They need our continued support.” These are some of the words expressed by former U.S President, the Honorable William J. Clinton, rallying support for the Batey Relief Alliance at its annual benefit concert held in Philadelphia on September 10, 2005.
This rare endorsement indeed represents a milestone – both for the Batey Relief Alliance (BRA) and for the vulnerable people of the bateyes in the Dominican Republic.
It is a proud moment and an honor for all of us at BRA as our effort is being recognized by others. Although we have a long way to go, but we are still convinced that as we continue to pursue our goals with a clear vision, great determination and discipline, many good things will happen, in time.
INTRODUCTION
I am writing to you today to present the 2005 State of the Batey Relief Alliance (BRA) – and to humbly present our sincere gratitude and thanks for your continued support that enabled us to bring critical humanitarian assistance to some of the Dominican Republic’s most vulnerable and impoverished populations.
This is our second year reporting in that fashion to you. We thought it is also a good and appropriate way to reflect on and share, before the year ends, the great things we accomplished together, the challenges that still await us, and the importance of making our partnerships even stronger in order to achieve greater goals and objectives.
For the past twelve months, BRA continued to demonstrate an organizational maturity to earn it the title “…one of the fastest growing organizations…” During that growth, however, we carefully evaluated our needs and new ideas, welcomed new partners, attracted additional funding, and expanded our programs in order to meet the continuing threat of HIV/AIDS and Tuberculosis, and the many other heath crises that affect the lives of thousands of women and children, and the elderly and the infant in the bateyes and other sectors of the Dominican Republic.
WHAT WE DID IN 2005
AN OVERVIEW OF BRA’S HUMANITARIAN INTERVENTION
Dr. William Duke, principal health advisor to USAID’s Project Conecta/Family Health International in the Dominican Republic, had the following to say after a visit to BRA’s health facilities inside bateyes Cojobal and Cinco Casas in the province of Monte Plata: “…It was of great satisfaction to witness the leadership BRA has in the province of Monte Plata and the critical health services that it offers.”
Through short and long-term health projects, the Batey Relief Alliance, through its sister organization, BRA Dominicana, delivered critical healthcare and essential medicines to 80,000 poor/marginalized Haitian immigrant families and Dominicans, of which, 10,000 received primary care and education at BRA’s mobile health clinic, medical center and medical mission trips, and another 70,000 through BRA’s medical donations to local partner organizations servicing other impoverished communities throughout the country.
The majority of BRA’s patients live in the bateyes – impoverished rural communities originally built to house Haitian migrant cane cutters working on sugar cane plantations. Today, most of the Dominican Republic’s sugar cane fields have closed, leaving tens of thousands of batey residents unemployed and in horrific leaving conditions. The people BRA’s projects serve are some of the poorest and most vulnerable in the country. Many of them cannot afford medical consults or even the most basic treatment. In addition, discrimination or fear of deportation deters some residents from seeking care in public hospitals. These poor, disenfranchised Dominicans and Haitian immigrants turn to BRA’s healthcare projects for help. For many, BRA offers the only viable source of healthcare.
BRA delivered general medical, dental and eye care through a number of programs and projects that focus primarily on the bateyes. The BRA’s 30-foot, fully equipped and staffed mobile health clinic stationed at Batey Cojobal has been in permanent operation since 2003, and saw a marked increase in patient visits between January and July. It is the only clinic in the entire province servicing the batey populations directly. The construction of BRA’s larger Health Center Complex located at Batey Cinco Casas is nearing completion, and opened a limited capacity in August. The center, when inaugurated in 2006, will be the first medical facility of that magnitude ever built inside the bateyes. The Dominican Ministry of Health’s HIV/AIDS branch, the DIGECTISS, visited the center in October and said, “…this health facility is definitely one of a kind and will serve as a model for the rest of the country.”
In addition to its permanent healthcare facilities, BRA actively carried out other important health programs. The “Salud Materno-Infantil” provides mothers and young children with free medical consults, Pap smear tests, and health and hygiene education. Our blindness prevention “I can See” program provides complete eye exam, prescription eyeglasses/sunglasses and drops to patients at the Mobile Clinic. In addition to these, BRA sponsored five weeklong medical and eye-care missions that brought emergency medical/dental/eye care to various needy communities throughout the country.
BRA is currently implementing other projects in HIV/AIDS/STIs prevention and treatment called “Project Arco Iris” (the Rainbow Project), Tuberculosis education and prevention – and is planning others in sponsorships of children and the elderly, condom distribution and ambulance emergency services. In April, BRA conducted at Columbia University in New York City its first conference on HIV/AIDS affecting both Haiti and the Dominican Republic. And in September, BRA sent 2-yr-old Jhensi Duran and his mother to the US for the child to receive a life-saving heath surgery from HeartGift.
BRA’S OPERATION IN THE PROVINCE OF MONTE PLATA
BRA’S MOBILE HEALTH CLINIC AT BATEY COJOBAL
The giant mobile clinic, stationed inside Batey Cojobal near the town of Sabana Grande de Boya, is now BRA’s primary full-time healthcare facility. The clinic is open five days per week, year round, and is staffed with an American volunteer Physician Assistant, a Dominican general practitioner, a Dominican optometrist, two foreign volunteer clinic administrators from Canada and the US, and two local community health promoters. One foreign nurse and five medical interns from Canada and the US also volunteered for one-month periods in the clinic.
The clinic offers, from Monday through Friday, general medical consults, complete treatment and medicines/vitamins to patients. On Thursdays, our optometrist provides vision consults and dispenses prescription eyeglasses through BRA’s blindness prevention “I Can See!” program. The clinic staff performs pap smears, Hemogram, and laboratory/HIV/AIDS/STIs tests every Wednesday afternoon. All care, medications/vitamins and prescription glasses are generally given out free of charge. At times, however, a symbolic contribution (roughly US$2) is asked of patients when visiting the clinic. The fee is merely to create a sense of community ownership, to prevent the destabilization of local economy, and to help create project self-sufficiency. Please note that no one is turned away because of money.
The Mobile Clinic saw 3315 (1361 of adults 25+, 631 of young adults ages 11 to 24, 1323 of children 0 to 23 – 888 were males and 2427 were females) patients from 68 communities. Of the 68 communities represented, 62 are in the vicinity of the Mobile Clinic, and 6 are located throughout the country. In many cases, patients travel for hours in pickup trucks, motorbikes, horses and on foot to receive treatment at the clinic. They are primarily residents of surrounding batey communities, although a significant portion also comes from the district of Sabana Grande de Boya and other poor rural towns. Though there is a hospital in Sabana Grande de Boya, many of the clinic’s patients cannot afford to buy the medicines prescribed by the hospital’s doctors. The BRA’s mobile clinic is the only full-time healthcare facility in the region that offers a reliable supply of medicines free, and for this reason, poor Dominicans also turn to BRA for help.
The clinic’s doctors treated a wide range of illnesses. Some of the most commonly encountered problems include: Parasitic infections, skin infections (predominantly fungal and scabies infections), gastritis, urinary tract infections, asthma, bronchitis, pneumonia, sexually transmitted diseases/infections, hypertension, chronic pain, and the common cold. Ailments treated by the optometrist include: Astigmatism, cataracts, eye infections, eye irritation, glaucoma, pterygia, toxoplasmosis, and near- and far-sightedness.
The clinic receives regular medical re-supplies from BRA’s storage warehouse located at its batey Cinco Casas medical center complex. Virtually all medicines distributed through the Mobile Clinic are first donated to BRA by partner international charitable organizations.
SPECIAL CASES
Though its primary purpose is to provide basic medical attention to batey residents, the BRA’s Mobile Clinic frequently encounters patients that need care beyond the capacity of its medical team. The clinic staff refers these patients to Santo Domingo and elsewhere for testing and treatment. In a few special cases, BRA volunteers accompany patients to the capital for referrals. In these cases, the patients often feel uncomfortable going to Santo Domingo alone (for fear of being turned away for documentation or discrimination) or lack the financial resources to pay for transportation and treatment.
Jhensi Javier, open heart surgery recipient – Case #1
In early March, Jhensi, a two-and-a-half-year-old boy from Sabana Grande de Boya presented with his single mother at the clinic with a congenital heart murmur. The child was underweight and developmentally delayed, and BRA’s doctors referred him to Robert Reid Cabral children’s hospital in Santo Domingo for evaluation. The boy’s family is extremely poor and was unable to follow-up on doctors’ earlier recommendations to see pediatric cardiologists shortly after the child’s birth. To ensure that the child was evaluated, BRA took responsibility for the costs of his diagnostic tests and transportation to the capital. He was diagnosed with Tetralogy of Fallot, a life-threatening condition that requires immediate surgical repair. Dominican surgery teams lacked the training and the health infrastructures to perform Javier’s heart repair. As a result, BRA solicited the help of HeartGift, a charitable organization based in Austin, Texas that performs open-heart surgeries on poor people living outside the United States. HeartGift evaluated Javier’s case and agreed to perform the surgery free of charge. When he first came to the clinic, Javier was one of the Dominican Republic’s millions of undocumented residents. BRA volunteers helped his mother declare him and rapidly procure a birth certificate that was necessary to get a United States visa. BRA then secured visas for both Jhensi and his mother from the American consulate and free round-trip tickets from American Airlines. The Washington-based Group of Dominican Professionals contributed more than $1200 towards his expenses. Jhensi (and his mother) traveled to the US in September, successfully underwent the heart surgery, and now is back home healthy. “…Because of BRA, my son is alive…” said Jhensi’s mother Hilda.
Ms. Cecil, HIV positive mother of four – Case #2
In December 2004, the Mobile Clinic diagnosed Ms. Cecil, a 27-year-old pregnant woman, with HIV. BRA doctors referred her to Santo Domingo to be entered in the Dominican Republic’s national vertical transmission prevention program. But because of financial constraints and recommendations from her family, Ms. Cecil failed to return to Santo Domino for her caesarian section and gave birth naturally in her home. In January, members of the clinic’s medical team visited Ms. Cecil, in her community. BRA doctors administered HIV tests to her four children and boyfriend and counseled her on her HIV status. During this first visit, Ms. Cecil, was depressed and confused about her condition. BRA volunteers continued to provide her and her family with support including Ensure nutritional supplements, vitamins, and baby formula to prevent the vertical transmission of the virus to her infant through breast milk. BRA also referred her to Project Vida Nueva at the Lotes y Servicios clinic in Santo Domingo. BRA paid for her transportation to Lotes y Servicios where she received monthly counseling sessions and medical consults. BRA also paid for a number of laboratory tests necessary for entrance in project Vida Nueva. After a few months, Cecil’s attitude had improved noticeably. She was no longer in denial of her HIV status and had taken responsibility for caring for her health. Now, Ms. Cecil is receiving life-saving antiretroviral medications from Lotes y Servicios. The clinic team sees Cecili’s emotional improvement each month when she comes to check in and receive money to cover the cost of transportation to her monthly appointments at Vida Nueva.
BRA’S HEALTH CENTER COMPLEX AT BATEY CINCO CASAS
In 2005, BRA continued construction on the bateyes’ first ever Health Center complex to be built inside the bateyes. Funding was secured from the Lions Clubs International Foundation, the Dominican’s State Sugar Council and the Clinton Foundation HIV/AIDS Initiative. The Cinco Casas facility includes a large building for medical consults, a second building for education and training seminars and patient counseling, a warehouse, an ambulance, and a dormitory to house long-term volunteers. The warehouse, the dormitory building and primary medical building will complete in December. The warehouse now serves as BRA’s primary storage facility of donated medicines, medical supplies and equipment. Three consult rooms will be fully finished to accommodate general medical consults, gynecology exams and patient counseling. The Cinco Casas facility will also serve as the center for BRA’s HIV/AIDS project “Arco Iris”.
When the Cinco Casas facility is inaugurated in 2006, it will provide consults and treatment in general medicine, pediatrics, vision care, gynecology and dentistry. It will also have a fully equipped laboratory from which BRA will perform laboratory tests, including the HIVAIDS CD4 test, as well as a space for educational seminars and counseling. BRA will equip the center with diagnostic equipment including an electrocardiogram machine and x-ray scanner. The center has an emergency room and one ambulance to deliver emergency services. The Health Center will be open five days per week, year round – and serve a total population of approximately 20,000.
HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS (STIS) INTERVENTION
USAID/PROYECTO CONECTA/FAMILY HEALTH INTERNATIONAL
Between January and March of 2005, as a part of coalition “Bateyes Sanos” of five local Non-governmental organizations (NGOs), BRA was subcontracted to carry out an HIV testing project funded by USAID’s Proyecto CONECTA through Family Health International. BRA doctors working at the Mobile Clinic and the Health Center administered medical consults, HIV tests, urine tests, Hemogram, and pretest counseling to 100 young men and women. Patients with illnesses received medications, and all patients received Ensure nutritional supplements. Sixty of the young people involved in the project were women, 40 were men, and three were pregnant at the time of their consult. Young people from 20 communities participated in the project. Two individuals, including Ms. Cecil, were diagnosed with HIV through the testing project, and both received home visits by BRA’s health team and further care following the project’s termination in March.
FURTHER CARE THROUGH THE MOBILE CLINIC
Impressed by BRA’s performance in the initial HIV/AIDS project, the USAID/Conecta restructured the project and selected BRA to become its primary contractor to work in a prevention and treatment program of HIV/AIDS inside the bateyes. BRA was awarded a grant of $100,000. BRA continues to provide care to a number of HIV patients living in the bateyes and poor rural towns of Monte Plata. In the first half of 2005, BRA encountered a number of HIV patients with a limited understanding of the disease and, in most cases, a sense of hopelessness about their future. The BRA health team counseled these patients and provided them with social support, medical care and referrals to other programs, thus giving them a better understanding of their condition and hope for the future.
The majority of the patients received medical consults, medications, vitamins and nutritional supplements from BRA. All received between one and five home visits by clinic staff, during which HIV tests were administered to the young children of two of the patients. Two children tested positive—the newborn child of Cecil, who were tested again in August, and a five-year-old patient whose HIV status was established in 2003.
In addition to providing medical care and social support to the patients, BRA attended to the family members of HIV patients. In all, BRA identified 14 children under the age of 18 and 4 affected adults living with HIV patients. Some of these affected individuals already received support in the form of medical consults, nutritional supplements, baby formula and vitamins. All are eligible for medical and social support through BRA’s health care facilities.
BRA referred three HIV patients for treatment with ART through the Vida Nueva program at the Lotes y Servicios clinic in Santo Domingo. Though Vida Nueva offers free medical care and ART to eligible patients in its program, most batey residents cannot afford the laboratory tests necessary to inscribe in the program and the cost of monthly transportation to Santo Domingo. BRA received a donation of $500 from Kate Fredlund, a graduate from Shepaug High School in Connecticut, who volunteered with one of BRA’s vision care missions in February, to support ground transportation and laboratory testing for our HIV patients. With the help of this fund, Ms. Cecil and another patient received a battery of laboratory tests including the CD4 test, and have already begun taking antiretroviral medications at Lotes y Servicios. The third patient referred to Lotes y Servicios came to the clinic in July and began treatment at Vida Nueva in August.
Three of the HIV patients BRA encountered in 2005 were pregnant when they first came to BRA for treatment. Two have since given birth. The first, Ms. Cecil, gave birth naturally against the advice of BRA doctors and the second was referred by BRA for a caesarian section and prophylactic treatment with antiretroviral medications. BRA provided Baby Formula to Ms. Cecil in an effort to prevent the transmission of the virus to her son via breast milk.
The third patient, Britania, is an extremely poor young Haitian immigrant with limited knowledge of Spanish. With BRA’s assistance, Ms. Britania inscribed in the national vertical transmission prevention project and is going to Hospital Maternidad Los Mina in Santo Domingo for monthly prenatal visits. She gave birth at Los Mina via caesarian section and received antiretroviral medications to prevent the vertical transmission of the virus to her child. BRA has paid for Ms. Britania’s transportation to the capital and the tests necessary to inscribe in the vertical transmission prevention program. BRA volunteers accompanied Ms. Britania to Los Mina for her first two visits to teach her how to arrive safely using Santo Domingo’s public transportation system.
PROJECT ARCO IRIS – COMPREHENSIVE INTERVENTION IN HIV/AIDS/STIS
Haiti and the Dominican Republic combined account for 85% of all HIV/AIDS cases in the Caribbean region. The bateyes account for 5% while the Dominican national average is only 1%. Yet batey-based HIV/AIDS intervention is extremely limited.
BRA is currently implementing in partnerships with USAID/Conecta/Family Health International, Columbia University’s Mailman School of Public Health and the Clinton HIV/AIDS Initiative the Project Arco Iris – a comprehensive HIV/AIDS prevention and treatment program which target 20 bateyes in the Monte Plata Province. The Dominican government HIV/AIDS branch, DIGECTISS, has agreed to sign a working agreement with BRA Dominicana to deliver HIV treatment at BRA’s medical center.
This project began in July with the training of local health promoters to give HIV preventative education seminars and monitor patients living in their respective bateyes. The project is multifaceted and over the next two years will include identification of patients, counseling, medical attention and laboratory testing including CD4 tests. It will also provide attention to pregnant women, and work to prevent the vertical transmission of the virus. At full capacity, the project will 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.
Please note that ART-antiretroviral therapy is new and very limited in the Dominican Republic. Local politics and a scarcity of the medicines make it extremely hard for the people of the bateyes to access ART. But through BRA’s partnerships and referral program with the Dominican’s Ministry of Health (SESPAS) and other local health organizations, some of our patients are now able to access the treatment.
One of BRA’s monumental goals for 2006 is to provide antiretroviral treatment to HIV/AIDS patients direct from its medical centers inside the bateyes. This will be a precedent, and tremendous improvement to BRA’s HIV intervention, as it would allow patients to receive these life-saving medications in a convenient location, thus avoiding costly and intimidating visits to Santo Domingo. With the support of Dominican’s DIGECTISS, concrete steps are now being taken to make this happen in 2006.
The project is comprehensive in that it attends not only to HIV patients, but also to vulnerable and otherwise affected children and adults living with HIV patients through food and clothing donations, economic self-sufficiency seminars, and counseling sessions. All HIV positive patients BRA is currently working with are automatically inscribed in Project Arco Iris along with their families.
SALUD MATERNO-INFANTIL AND HIV/AIDS VERTICAL TRANSMISSION PREVENTION PROJECT
In 2005, BRA continued its infant health and vertical transmission prevention project, which began in 2004. This project, funded through the Canadian Embassy’s “Fondo Canadiense para Iniciativas Locales” (FCIL), trains local health promoters and BRA medical teams, educates batey residents on the subjects of vertical transmission of HIV and child nutrition, and provides primary health care to mothers and children under the age of five. The project worked with seven bateyes in the Monte Plata province: El Bosque, La Cerca, Cinco Casas, Cruce de la Jagua, Deán, Payabo, and Triple Ozama.
BRA put on four training seminars—two on the subject of vertical transmission of HIV/AIDS and two on the subject of sexually transmitted diseases. The seminars were given in Batey Cojobal and Monte Plata for the health staff of the BRA, 15 people attended these training sessions. In addition to these training sessions, BRA provided 2 educational seminars for the health promoters working in the bateyes surrounding the Health Center at Batey Cinco Casas residents of each of the seven bateyes. These seminars covered the topics of infant and child nutrition and prevention of the vertical transmission of HIV from mother to child.
In addition to the educational aspect of the Infant Health project, BRA provided primary health care to 508 patients through temporary clinics opened within each community. BRA’s health intervention targeted mothers and their young children, but was also available to other batey residents. Patients received free medicines and baby formula as needed, and 87 women received pap smears. Below is a breakdown of patients by demographic groups and a list of services provided:
Total Patients 508 Services Provided
Women (ages 15+) 224 Pap smear tests 87
Men (ages 15+) 42 HIV vertical transmission prevention charlas seminars 7
Female Children (ages 0-5) 242 Nutrition seminars 7
Male Children (ages 0-5) 227 Training sessions for health staff & health promoters 3
TUBERCULOSIS EDUCATION AND PREVENTION
In conjunction with the USAID’s Project CONECTA and the Dominican Republic’s National Tuberculosis Control Program, BRA initiated in August a nationwide program to control tuberculosis inside the Dominican Republic’s bateyes. This project trains a network of community health promoters in 40 bateyes in the province of Monte Plata to identify patients showing signs of tuberculosis and refer them for testing. Those who test positive are referred for treatment with directly observed therapy. The local health promoters are also trained to give educational seminars in their respective communities on the identification and treatment of tuberculosis. In addition to identifying cases and educating rural communities, BRA is providing support to patients and their families through home visits and food donations. The project also seeks to identify and refer for treatment patients suffering from TB/HIV co-infections.
Nota Bene: A number of provinces outside of Monte Plata, including Barahona, La Romana, Higuey, and San Pedro de Macoris are experiencing a high rate of tuberculosis infection. Because local organizations working in those cities have not participated in the eradication campaign, BRA has been asked to extend its preventative intervention program into La Romana and Higuey.
SHORT-TERM MEDICAL AND EYE MISSION TRIPS
In addition to its permanent healthcare programs, BRA also sponsors short-term volunteer medical and eye care missions to the Dominican Republic, on which volunteers from North America and other parts of the world spend one to two weeks providing free care and medicines inside the bateyes and other impoverished communities where BRA or its member/partner organizations operate. When permitted, follow-up care is provided by BRA after the missions end. BRA sponsored five such missions in 2005—two optometry and three general medical —which saw a combined 6,760 patients from 62 communities. Statistics below represent the total contribution of BRA’s five missions:
Medical Missions, January to October 05’
Total patient consults 6,760
Prescription glasses donated 2,624
Sunglasses donated 2,910
Communities served 72
American volunteers 111
Local support staff 136
OPTOMETRY MISSION WITH VOSH WISCONSIN, FEBRUARY 19 TO 24
BRA’s first mission in 2005 was carried out in conjunction with Wisconsin-based Volunteer Optometrists for Service of Humanity (VOSH). The program was supported in staff and logistics by the Dominican’s State Sugar Council (CEA) and the local Lions Club Arroyo Hondo. Seven volunteer optometrists, opticians and support staff worked for a week in Batey Guayabal, near the town of Boca Chica. The VOSH team saw 503 patients and dispensed 377 pairs of glasses to the residents of Guayabal and nearby communities suffering from hyperopia (farsightedness) and myopia (nearsightedness). VOSH optometrists also treated a number of eye disorders including glaucoma, toxoplasmosis, eye injuries and infections. In addition to dispensing medicines and prescription glasses, the VOSH team provided eye drops and sunglasses to ease discomfort from allergies, chronic dryness, pterygia and cataracts. Many of the patients seen by the VOSH team were too poor to seek vision consults or buy glasses on their own. “Upon receiving their first pair of glasses, these patients were astounded to be able to see clearly for the first time in years,” said Cheryl Armstrong, VOSH leader. In two cases, glasses with large prescriptions were custom-made in the United States and hand delivered to patients after the mission.
OPTOMETRY MISSION WITH VOSH BOSTON-NECO, MARCH 12 TO 21
The second optometry mission took place in March in Batey Central in and Villa Jaragua near the province of Barahona. Twenty-four optometrists and optometry students saw 1,820 patients from 17 communities and distributed medicines, eye drops, prescription glasses and sunglasses. The VOSH team treated patients suffering from glaucoma, cataracts, eye irritation, conjunctivitis and eye infections. In addition, two dentists working with the Dominican’s State Sugar Council provided dental care to 69 patients. Santo Domingo Arroyo Hondo Lion’s Club and the Solidarity and Development Foundation provided logistical support for this mission. Many cases of cataract and glaucoma were seen, and the mission team is not equipped to perform surgeries. BRA hopes to secure volunteers ophthalmologists in 2006 to come to the Dominican Republic to perform surgeries at the DR Air Force-based military hospital in Santo Domingo.
GENERAL MEDICAL MISSION WITH AMHE, APRIL 25 TO 29
A group of 32 medical professionals from the United States specializing in the fields of internal medicine, pediatrics, cardiology, oncology, dentistry and nursing traveled to Batey Las Pajas in the Hato Mayor Province to provide medical consults to residents of Las Pajas and 13 neighboring communities. BRA partnered with the Association of Haitian Physicians Abroad (AMHE), which contributes each year dozens of US-trained Haitian physicians to provide care to the batey population. This type of collaboration is particularly important because, in addition to providing medical care to the population, it helps raise the self-esteem of poor Haitians who are persistently marginalized in the Dominican Republic. In total, the team treated 1,875 patients, distributing necessary medicines free of charge. Doctors treated patients presenting with the following ailments: Hypertension, arthritis, anemia, parasites, gastritis, skin infections, headaches, fungal infections, bronchitis, pneumonia, chronic diarrhea, vaginal infections and malnutrition. Alas de Igualdad and the Santo Domingo Arroyo Hondo Lion’s club provided local support to this mission.
GENERAL MEDICAL MISSION WITH LOUISIANA STATE UNIVERSITY, JUNE 1 TO 9
A group of 22 doctors and medical students from LSU worked in the impoverished Libertador de Herrera slum neighborhood (barrio) of Santo Domingo and Batey las Salinas near the town of Barahona. These doctors worked in conjunction with BRA coordinators and support staff from COSALUD and La Iglesia Episcopal Jesus Peregrino to provide medical care and free medicines to 1,213 people. Patients from 11 communities received medical attention. Common ailments encountered included: Parasites, anemia, arthritis, diarrhea, skin infections, fungal infections, hypertension, gastritis, and the common cold.
GENERAL MEDICAL MISSION WITH AMHE-FLORIDA, OCTOBER 16 TO 23
A group of 25 medical professionals from the United States specializing in the fields of internal medicine, pediatrics, cardiology and nursing traveled to the bateyes in the El Seybo to provide medical consults to residents of the batey communities. In total, the team treated 1,175 patients, distributing necessary medicines free of charge. Doctors treated patients presenting with the following ailments: Hypertension, arthritis, anemia, parasites, gastritis, skin infections, headaches, fungal infections, bronchitis, pneumonia, chronic diarrhea, vaginal infections and malnutrition.
OTHER: DONATION OF SHOES WITH THE SUZIE REIZOD FOUNDATION, AUGUST 26 TO 30
The BRA partnered with the New York-based Suzie Reizod Foundation to distribute 50 new pairs of shoes to children between the ages of 1-18 living in the bateyes where BRA operates in Monte Plata. Families of the bateyes often are too poor to buy a pair of shoes for their children. As a result, they walk bare foot and contract parasitic ailments, which often become the lead cause of other serious diseases. As a preventive mechanism, the children and their families received the shoes; learned basic education on the importance of wearing them, and its preventive health capability to deter diseases.
MEDICAL DONATIONS
This year, BRA secured more than $5.4 million in donated medicines, medical supplies and equipment. A portion is used to support BRA’s direct health inside the bateyes intervention – and the rest helped the capacity of local partner groups to deliver improved health services to their respective impoverished communities around the country.
PLACEMENT OF VOLUNTEERS
As part of its humanitarian health intervention inside the Dominican Republic, BRA mobilizes from the United States and Canada experienced volunteer health care providers to work alongside their Dominican counterparts at BRA’s health facilities and mission trips. The program is greatly supported by the Catholic Medical Mission Board. BRA also places volunteers at some of the BRA’s partner organizations’ health facilities. This year, COSALUP based in Santo Domingo and Alas De Igualdad based in Hato Mayor were recipients of BRA’s sponsored health care volunteers.
This year more than 200 volunteers traveled to the Dominican Republic to work with BRA in health care, technical assistance and administration. Local health professionals share their expertise with the visitors who do the same from a western health care point of view. Please note that the Dominican’s Ministry of Health approved the assignment to BRA of five of its commissioned health care providers to work permanently at BRA’s health care facilities in Monte Plata starting August.
BATEY RELIEF ALLIANCE’S ANNUAL INTERNATIONAL CONFERENCES
The New York Chapter of the Batey Relief Alliance, in collaboration with the Barnard College’s Haitian/Dominican Students Associations and the Columbia University Family International AIDS Program, held its Third Annual International Conference entitled “HIV/AIDS in Haiti and the Dominican Republic: A Bilateral Challenge.” First of its kind, the forum was held on Saturday, April 30th, 2005 at Columbia University, Schapiro Center, Davis Auditorium in New York City. This event was part of BRA’s Public Awareness and Education campaign where BRA holds annual conferences in the US to address bilateral issues affecting both the Dominican Republic and Haiti.
Leading experts were invited from the United States, Haiti, Canada and the Dominican Republic to assess the current state of HIV/AIDS in the Dominican Republic and Haiti, and to discuss responses to prevention and treatment in both countries. Speakers from several prominent organizations participated, including USAID/Conecta, Bill Clinton Foundation, Dr. Paul Farmer’s Partners In Health, Cornell University/GHESKIO (speaker was Dr. William Pape), COIN, COPRESIDA, PSI, University of Vermont, SMARTWork-Haiti, and others. The event was co-sponsored by the Bill Clinton Foundation, the University of Vermont, COPRESIDA and USAID/CONECTA.
RESOURCES ACQUISITION
This year, BRA raised close to $400,000 in cash to carry out its projects. More than $5.4 million in in-kind gifts was also secured to support our health care services. But an accurate account will be available through BRA’s 2005 IRS 990 Tax return.
BRA is able to provide medicines and glasses free of charge to its patients. It does so by soliciting donations of medicines, medical supplies and equipment from the United States and Canada. In 2005 the following international organizations contributed to BRA’s healthcare intervention: Food for the Poor, Catholic Medical Mission Board, Direct Relief International, Interchurch Medical Assistance/Week of Compassion, Church World Service, New Jersey Eye Glass Recycling Center, and Colaboration Sante Internationale. BRA also received donations from a number of generous individuals.
As part of its humanitarian health care expansion in the Dominican Republic, BRA also distributed donated medicines and medical supplies to partners of its Dominican-based Alliance working in the area of health care inside impoverished bateyes, urban slums and rural communities where the population is too poor to afford basic medical consults, treatment and medicines. Through these donations, BRA raises the partners’ capacity to become more effective in delivering care in locations where BRA does not operate directly. This year, BRA made donations to seven local grassroots organizations in Santo Domingo, Santiago, Hato Mayor, San Pedro de Macoris, Manzanillo, Neyba, Monte Plata and Barahona; three rural clinics in the South; three government hospitals, the Dominican’s State Sugar Council (CEA), and the Ministry of Health (SESPAS). Approximately 70,000 persons have been served as a result of BRA’s donations.
ANNUAL BENEFIT CONCERT
BRA held its second annual benefit concert in Philadelphia on September 10, 2005 at the Church of the Saviour. The event entitled, Partners In Hope Concert, attracted 48 top musicians from the Cleveland Orchestra, the Philadelphia Orchestra, and the Boromeo Street. Funds raised were allocated to help advance BRA’s humanitarian mission.
OTHERS
§ This year, BRA became the recipient of the Google Ad Program donating to our organization free ad publicity of its work on the Internet. Viewers can find BRA’s website by performing a Google search with specific key words. The feature helps expose BRA’s work to billions around the around.
§ We created a third BRA-Chapter in Philadelphia. The group’s main functions are to help advance BRA’s work, specifically by organizing annual benefit concerts in Philadelphia. BRA currently has other chapters in Kansas City and New York.
WHAT WE WILL DO IN 2006
With great pride, BRA and its partners look forward to establishing the first ever HIV/AIDS treatment (ARVs) program for batey AIDS sufferers at BRA’s medical center. Additionally, BRA will actively carry out twelve projects inside the bateyes. The followings are new: The batey Cinco Casas medical center scheduled to be in full operation in 2006. The ambulance emergency services – a project of great significance because it is the first emergency system ever available for the bateyes and will help save many lives. In effort to help reduce drastically HIV/AIDS cases, BRA is partnering with PSI to make readily available and distribute low-cost condoms to batey residents.
The following projects are ongoing: The batey Cojobal Mobile Clinic, HIV/AIDS prevention and treatment, Tuberculosis treatment, Blindness prevention, Medical mission trips, Medical donations, Volunteer placement, International Dialogue and Disaster relief.
BRA, in collaboration with Margarette Sanger International, submitted a proposal to the UNIFEM focusing on domestic (sexual) violence against women in the bateyes. BRA is also pursuing a sponsorship program, in partnership with the Kansas City-based Christian Foundation for Children and Aging, to facilitate the donations of food, clothing, school supplies, building materials and other forms of assistance to 100 children and the elderly in the bateyes. BRA seeks to extend its humanitarian intervention by addressing other important human needs of its target populations outside the area of healthcare.
CHALLENGES – ESSENTIAL COMPONENTS FOR SUCCESS OF BRA
1. Increased Financial Independence (IFI).
BRA’s operation is extremely under-funded. The organization does not have major sponsors to fully support its program expenses. We only rely on limited financial support from a number of organizations, the church and individual donors to carry out the many ambitious projects BRA undertakes. A high percentage of the organization’s total budget covers project delivery. The rest only covers small stipends for volunteers – and salaries for a limited staff. As BRA grows steadily into a well-developed organization and undertakes large-scale projects, it is crucial that we receive adequate funding from our donors to develop a professional and capable operating staff. Funding support in organizational capacity building and staff development is urgently needed.
Also project-funding organizations too often put stiff requirements on the organization to allocate almost the entire operating budgets to the projects. This limits BRA’s ability to design and carry out projects creatively. An increase in BRA’s general budget would free the organization from constraints imposed by other institutions and allow it to break ahead of the pack and implement the most effective projects.
The following specific needs could be addressed by an increase in funding:
· Improved services at BRA’s mobile clinic: hire a sustainable staff and purchase necessary supplies and equipment.
· Operation of the new Health Center: ensure the complete operation of the facility at its full capacity with reliable personnel and modern equipment.
· Transportation costs for patients: many patients who cannot be treated directly through BRA’s health facilities go untreated because they lack the money to travel to other sites for essential, and at times, free treatment. Many cannot even afford to travel from their home bateyes to BRA’s clinics. Transportation is one of the biggest and most frequently ignored challenges facing healthcare providers working in the bateyes. Partner organizations often neglect to provide BRA projects with sufficient transportation budgets to meet the challenges.
2. Increased Support Capacity (ISC)
BRA now has two operating health facilities servicing a population of approximately 20,000 annually. More than 90% of the residents are too poor to afford basic medicines. While the number of patients served by BRA is expected to triple in the coming year, the amount of donations BRA receives annually has decreased dramatically because of sudden cuts from pharmaceutical companies to our donors. It is absolutely essential that BRA address the issue of medical re-supply if its projects are going to survive. With the increased patient load of the Cinco Casas facility, irregular donations of medicines will not be a viable supply system. In order to efficiently and effectively supply its two clinics, BRA needs to secure a regular source of monetary donations to buy low-cost medicines not received in donations.
WHO SUPPORTED BRA’S WORK IN 2005?
This year, BRA created new partnerships with solid institutions to help advance its humanitarian mission. BRA became for the first time a direct contractor with the USAID/Conecta Project implementing a comprehensive HIV/AIDS prevention and treatment project inside the bateyes. The Clinton Foundation’s HIV/AIDS Initiative donated $50,000 towards the completion of BRA’s new medical center – and, along with the Columbia Mailman School of Public Health, is collaborating with BRA’s HIV/AIDS program in technical assistance and in donation of antiretroviral treatment. DIGESTISS, the Dominican Republic’s Ministry of Health’s HIV/AIDS service branch, is scheduled to sign a partnership agreement with BRA to deliver HIV treatment to HIV batey sufferers at BRA’s medical center. Other new partners included the International Foundation and the White Bird Philanthropy.
Of course a great portion of BRA’s work is still generously supported by the following ongoing funders/supporters/partners: Lions Clubs International Foundation, St. Joseph Hospital Exempla Foundation, New Jersey Lions Eyeglass Recycling Center, Wallkill Valley Rotary Club, Club Rotario Arroyo Hondo Santo Domingo, Catholic Medical Mission Board, Direct Relief International, Food for the Poor, Disciples of Christ’s Week of Compassion, Interchurch Medical Assistance, Country Club Christian Church, Union Hill Presbyterian Church, Church World Service, Dominican’s Ministry of Health (SESPAS), Dominican’s State Sugar Council (CEA), Barnard College’s Haitian/Dominican Students Association, the Association of Haitian Physician Abroad (AMHE), the Washington-based Group of Dominican Professionals, VOSH, and individual donors.
Other partnerships BRA is currently pursuing are: Planned Parenthood International’s Margarette Sanger International, Plan International, PSI and the Christian Foundation for Children and Aging.
IMAGES OF BRA’S HEALTH CARE INTERVENTION
Instructions: To view images, you must first be connected to the Internet and click here: http://www.bkreative.net/client-bateyrelief/gallery/BRAs-2005-Health-Care-Humanitarian-Health-Care-Intervention.
REMARKS
HEALTH ACESS FOR RESIDENTS OF THE BATEYES: A BATEY-BASED INTERVENTION.
In 2005, more than five decades after their official creation, the 220 bateyes of the Dominican Republic continue to represent a socio-economic nightmare for more than 200,000 poor marginalized Dominicans and Haitian immigrants who officially live there and those who endeavor to better their conditions. Batey-based health intervention, for example, is severely neglected while residents still are unable to comfortably access basic services outside their communities. Extreme poverty, discrimination or fear of deportation continues to deter many batey residents from seeking public assistance, even under critical health circumstances. With the highest rates of infant mortality and birth, HIV/AIDS and Tuberculosis, sexually transmitted infections, poverty and unemployment, illiteracy, the batey situation could represent a timed-ticking bomb ready to explode at any moment with immeasurable casualties.
The batey situation is a humanitarian crisis that warrants a swift humanitarian response, irrespective of those historical, cultural or political realities that plague it. Any health intervention, for example, to help improve living conditions in the bateyes cannot be expected to produce great success unless it is comprehensive, collaborative, and is done inside a centrally located batey where its residents and those of other surrounding communities have free and reasonable access to services. If the residents cannot access or are afraid of accessing outside services, we simply must then bring the care to them.
We call this a batey-based humanitarian health intervention where services are freely delivered to the population inside their batey communities. Services established around or at the border of batey lines simply will not be adequate for the population will continue to feel scared, vulnerable or impotent to overcome barriers. The “freely” delivery will occur when the population feels psychologically and physically able to access services. The psychological access will be guaranteed when and only when the population no longer feels the unbearable burden to travel kilometers to facilities outside its communities seeking assistance with the fear of being rejected. The physical access will be met when and only when the population can freely and reasonably move from its abodes to receive affordable, dignified and culturally-oriented services inside its own communities.
Once these two basic criteria of access are met, the batey-based intervention will not only help deter the stigmatized population’s fear of rejection outside its batey boundaries, but also capture patients’ trust critically needed to ensure a lasting patient-provider relationship. Moreover residents will enjoy a higher self-esteem as they feel they are, for once, partners to a health care delivery system that provides them with the opportunity to actively participate in the administration of care to members of their own communities.
The batey-based intervention must be comprehensive not only to guarantee the population basic health services and medicines, but also to respond to the population’s other basic survival needs. A Tuberculosis sufferer who only receives medications without food will likely die of hunger or starvation. The same will occur for an HIV/AIDS patient undergoing antiretroviral therapy without food or treatment against opportunistic diseases. It is simply ill conceived to expect a population living in such extreme poverty to meet all of its daily living necessities.
The batey-based intervention must be a collaborative endeavor involving the State of the Dominican Republic, members of the recipient batey communities, local partner NGOs, and the international community. Each partner with specific expertise and resources must be consulted, relied upon and used in specific areas to help create an intervention that is comprehensive, dependable and sustainable.
This concept of a batey-based intervention is revolutionary and has been the very model for the success of BRA’s humanitarian work since its inception in 1998. Through various bona fide partnerships with Dominican governments, the batey population and the international community, we were able to establish in 2003 the first ever fully-equipped and staffed (mobile) medical clinic, and are now building the first medical center complex inside the bateyes. Both facilities are located in the province of Monte Plata at bateyes Cojobal and Cinco Casas – and starting in 2006, will deliver to more than 17,000 annually primary medical/dental care and essential medicines, HIV/AIDS prevention and (ARV) treatment, Tuberculosis education, Laboratory and other diagnostic services, Ambulance emergency services, Nutrition, Capacity building of health promoters, and Preventive health education. Other programs BRA will continue to implement include, Blindness prevention, Medical missions, Medical donations, Placement of volunteers, Condom distribution, Child/elderly sponsorship, Disaster relief, and International dialogues. This type of intervention has helped and will continue to help save more than 80,000 lives each year inside the bateyes – and other impoverished communities.
The BRA’s adopted model of a batey-based intervention represents a new beginning on how we must view and deal with the batey situation and the plight of its populations – if we seek concrete changes. The character of what we will do from now on “on behalf of the batey populations” will depend on how we understand and value this model of work. Addressing the tragic situation in the bateyes in its fullness is a human investment that is long overdue, irrespective of race, creed, national origin or political affiliations. It is important to take a heart, free of political or personal interests, what is at stake – the lives of hundreds of thousands of innocent women, men and children who are eager to live, grow and produce. We just have to understand that where there is a human investment in a community, we all will likely benefit, and where there is none, we all will likely suffer. This is a basic natural law we simply cannot escape.
LOOKING FORWARD TO THE FUTURE WITH YOU
You have been with us in our endeavors; helped us grow and accomplish so much in so little time. Those challenges that await us will be overcome with your continued support as we tackle them with conviction one at a time. BRA depends on your bona fide partnerships as we move forward to make the next year as rewarding as 2005.
On behalf of our Board of Directors and those we serve, we thank you and wish you and your family a Happy Holiday season and a wonderful new year.
Respectfully,
Ulrick Gaillard, J.D.
CEO
