11 October, 2006
I. INTRODUCTION TO BRA’S HUMANITARIAN WORK
BRA’s Institutional Model
The Batey Relief Alliance—BRA was created in 1997 in the State of New York, United States, as a 501c3, tax-exempt, non-profit, humanitarian aid organization to address the socio-economic conditions of children and families severely affected by poverty, disease and hunger in the Caribbean. Toward that end, BRA created in 2000 its regional arm inside the Dominican Republic, the BRA DOMINICANA, a non-governmental organization—NGO designed to help the Batey Relief Alliance carry out its humanitarian mission inside the Dominican Republic’s bateyes, rural/urban slums and border localities.
The BRA has a board of directors that meets once a year in New York and a Chief Executive Officer who is charged to mobilize public resources for the work of the institution and the BRA Dominicana to implement BRA’s projects. BRA Dominicana, as a legally created Dominican entity, runs the entire field operation for the Batey Relief Alliance, raised local funds, has an office in Santo Domingo with paid staff and volunteers, and runs projects and manages two modern medical facilities in Monte Plata. BRA Dominicana has its own board of directors and an Executive Director who is charged of running the show for the Batey Relief Alliance in the Dominican Republic. BRA’s CEO, however, oversees the entire field operation, the sustainability and growth of the institution. BRA’s Board of Directors is the ultimate body on policy decisions affecting both the Batey Relief Alliance and BRA Dominicana.
BRA’s CEO mobilizes public resources from the United States that are cash and/or in-kind donations. Most cash gifts are from individual donors, international organizations and foundations. In-kind donations are mainly from international organizations. When non-restricted cash is received, it is used to sustain the virtual operation of the BRA in New York, sustain part of the field operation’s costs of BRA Dominicana, and implement projects. All restricted funds are transferred to BRA to implement projects overseas. BRA Dominicana puts all funds received in bank accounts, registers them in its accounting books, uses them for the projects, and sends to BRA annual reports for funders and donors. BRA Dominicana’s board maintains a strict control over the organization’s public-raised funds, accounting, and projects’ implementation.
As for in-kind donations, BRA’s CEO receives requests from the field office of the needs (in medicines, supplies and equipment) to sustain the operation. BRA’s CEO then forwards that wish list to donors for support. When donations are considered, a detailed list is sent to BRA’s CEO in New York for acceptance. Once BRA’s CEO accepts the donations, the donors then send a list, with dollar values, to BRA Dominicana notifying the donation and preparing to retrieve them out of the DR customs. Once the donations have arrived at the DR customs/port, BRA Dominicana is the consignee to receive the donations. BRA Dominicana also receives the support from the Dominican government to custom free retrieve the donations. BRA Dominicana retrieves the donations and transports them to the organization’s warehouse in Monte Plata for an inventory.
Once the inventory is completed, a product report is sent to Batey Relief Alliance of the receipt of the donations and the quantity received. BRA Dominicana is then free to use the donations for its humanitarian projects. BRA has a strict policy of not selling or exchanging donated products designed for its projects. A portion of the donations is sometimes distributed to key BRA’s local partner organizations increasing their capacity to deliver improved services to various other impoverished communities around the country. All BRA’s patients receive low-cost or free medical services and free medicines. Annual work reports are prepared by BRA Dominicana and sent to Batey Relief Alliance for evaluation and forwarding to international donors, partners and volunteers.
Humanitarian Health Intervention
Since 1998, the Batey Relief Alliance—BRA, through its regional arm BRA DOMINICANA, has provided health care and social services inside the bateyes and rural communities of the Dominican Republic through medical/eye care mission trips, its mobile clinic and health center, and a network of community-based health promoters. The Batey is the Dominican word for sugar plantations rural community where Haitian immigrant workers and their descendents traditionally live and work. Today poor Dominicans as well as Haitians share the Batey habitat. Conditions in these quasi-isolated communities are abysmal; there is often no water, latrines, or garbage collection. Access to healthy food, medicine, employment, and education are extremely limited. Malnutrition and disease are rampant. People in the bateyes bear the additional burdens of racial discrimination and fear of deportation to Haiti—a result of the deep-seated anti-Haitianism that has persisted in the Dominican Republic for years. This discrimination makes it difficult, if not impossible, for batey residents to freely access health services outside of their communities.
BRA’s pioneer community-based approach to heath care—bringing the care to the population inside their own batey communities, starts with volunteer health promoters, who work in over 62 bateyes in the province of Monte Plata. BRA’s promoters provide education and counseling in their communities and referrals to BRA’s health services among a population of over 200,000 people. At our mobile clinic and health center, teams of health professionals provide primary health care, essential medicines, and preventative health services to batey residents including special services of optometry, gynecology, and HIV/AIDS care. BRA also runs four major programs that target specific health problems faced by the batey communities. These programs focus on HIV/AIDS, Tuberculosis, Blindness Prevention, and Access to Potable Water. Additionally, we provide primary health, dental, and vision care through short-term medical missions within the bateyes. BRA’s 2006 staff includes 46 full-time and part-time employees and foreign volunteers, 38 of which are health related. Through medical missions and long-term health projects, BRA provided critical health care and social services to over 60,000 people from August 2005-July 2006. For many people, BRA offers the only viable source of healthcare and social services in the region.
II. BRA’S OPERATION IN THE PROVINCE OF MONTE PLATA
BRA’s health facilities include a 30-foot, fully equipped and staffed Mobile Health Clinic stationed inside Batey Cojobal, in operation since 2003, and a new Health Center inside Batey Cinco Casas, open full-time since January 2006. In addition to its permanent healthcare facilities, BRA carried out in 2006 four other major health programs. In its fight against AIDS since 2005, BRA runs a comprehensive HIV/AIDS program that delivers to impoverished and marginalized AIDS sufferers antiretroviral treatment—ARV and a cadre of associated services free of charge. BRA’s community-based AIDS treatment strategy is a model that is being repeated countrywide. BRA also works closely with the Dominican National Program to identify and treat Tuberculosis among Batey residents. BRA also implements a Blindness Prevention Program that provides vision care and free prescription eyeglasses. This year, BRA began a Potable Water Program , distributing Biosand Water Filters and PUR water purification tablets in the bateyes. In addition to these programs, BRA coordinated a weeklong medical and eye-care mission in April.
In 2006, BRA launched four additional programs: Condom Distribution making low-cost condoms available to Batey residents to reduce rates of infection; a Suzuki Music Program providing cello and violin lessons to 18 kids from the bateyes with the long-term plan of creating a Batey Youth Orchestra; a Medical Sponsorship Program helping to support the professional service of local healthcare providers working at BRA’s medical facilities; and a Child Sponsorship Program.
The following three projects are at a planning stage and will be implemented in the near future: Vitamin/Deworming distributing for three years multivitamins+A and worm medicine to 55,000 children (2-10 years of age); and a Permanent Home for children infected by HIV/AIDS and those who are abandoned and severely affected by the disease, poverty and hunger.
A. MOBILE HEALTH CLINIC IN BATEY COJOBAL
BRA’s Mobile Clinic is permanently located in Batey Cojobal near the town of Sabana Grande de Boyá. The clinic is the only one in that zone fully-equipped and staff providing complete health services with free medicines to the population. It is open five days a week, year round. Consultations are available for a small fee and medicines are provided free of charge. The clinic is staffed by an American physician’s assistant, a Dominican general practitioner, a Dominican optometrist, an American volunteer administrator, a Dominican nurse, and two clinic assistants from Batey Cojobal.
In addition to general medical consultations, BRA’s clinic offers specialty services. On Thursdays, BRA’s optometrist provides vision consultations and glasses through our blindness prevention program. The clinic’s staff performs pap smears every Wednesday (To date, sixty-one Papanicolaou were provided to patients). The following demographic groups received services:
Table 1. Mobile Clinic Patients
Patient Group No. of Patients
Boys (0-10) 983
Girls (0-10) 1081
Adolescent Boys (11-18) 76
Adolescent Girls (11-18) 102
Men 1229
Women 2153
Total 5624
From August 2005-July 2006, the Mobile Clinic saw 5624 patients for primary care. Based on the clinic’s data , approximately 60% of the patients are new. Accordingly, in 2006-2007, BRA expects to see a patient visit increase of over a thousand new patients. BRA is now reaching out even more to the community through publicity, words of mouth, and its permanent establishment in the area over the past 3 years. It is necessary for us to respond to this patient increase by augmenting our clinic’s space and staff and assuring that we have sufficient medicines and materials to serve the needs.
Among the patients who visited the clinic, about 33% are from the bateyes, 41% from Sabana Grande de Boyá, and the remaining 26.6% from rural communities. Although there is a hospital in Sabana Grande de Boyá, many patients cannot afford to buy the medicines prescribed by the doctors. Our Clinic is the only full-time healthcare facility in the region that offers medicines free, and for this reason, many poor Dominicans also turn to BRA for help. For many living in isolated bateyes, transportation is still a major obstacle to reach our clinic. BRA has begun addressing this problem among our HIV/AIDS patients by providing free transportation to our health care facilities.
Health providers at the BRA’s clinic treat a wide variety of health problems. The most prevalent are listed in Table 2.
Table 2. Common Health Problems at the Mobile Clinic
Health Problem Prevalence
Fungal infection (skin) 18.2%
Cold 16.7%
Intestinal parasites 13.8%
Scabies 13.2%
Headache 12.9%
Hypertension 12.1%
Bronchitis 7.2%
Skin sores 5.9%
Back pain 5.7%
Dizziness 5.3%
The BRA’s Clinic receives medicines regularly from BRA’s storage warehouse at the Health Center in Batey Cinco Casas. However, maintaining a steady supply of essential medicines continues to be one of the biggest challenges the mobile clinic faces. Approximately 97% of patients who visit the mobile clinic receive medicines and about 23% receive prescriptions. While few are going home empty handed, about a quarter still purchase medicines with their own resources. Virtually all medicines distributed through the Mobile Clinic are first donated to BRA by international charitable organizations and BRA is constantly soliciting new donations. Additional medicines are purchased on the local market by physician assistant, Alan Kerr, about $700 per year, with the support of the First Congregational Church of Albany, New York.
About 36% of patients in the clinic are sent for lab analyses, usually at the public hospital or private labs in Sabana. Stool and blood analyses are the most commonly required tests. This not only represents a significant additional cost for patients in terms of transportation, cost of medicine, and lab fees, but can also be a barrier to health care considering the discrimination and fear that patients from the bateyes may face entering the Dominican public health system. BRA has resolved this problem by establishing a brand new, fully equipped and capacitated laboratory at the health center in Cinco Casas.
B. HEALTH CENTER COMPLEX AT BATEY CINCO CASAS
By the end of 2006, BRA will be completely finishing construction of the bateyes’ first modern Health Center located in Batey Cinco Casas in the province of Monte Plata with funding from the Lions Clubs International Foundation, the Dominican’s State Sugar Council and the Clinton Foundation. Local Dominican Newspaper HOY said in its 2006 April article—VIVIR that BRA’s Center is the first modern medical facility ever built inside the bateyes since the start of sugar cane plantations on the island more than 400 years ago. The Cinco Casas facility includes a medical building with consultation rooms and a laboratory, a building for education, training seminars, and patient counseling, a warehouse, and a dormitory to house local doctors and foreign volunteers. There is a playground and a garden where patients and children can wait and play.
The Health Center’s includes a full-time personnel of 32, including physicians, psychologists, optometrist, dentist, nurses, administrators, receptionists, pharmacy workers, volunteer health educators, and community health promoters.
Since January, the health center has been open five days a week providing medical, dental and vision services. It is also where BRA provides comprehensive antiretroviral treatment to Batey AIDS sufferers in partnership with the Clinton HIV/AIDS Initiative—CHAI (discussed below) and the Dominican Ministry of Health’s DIGECITTS. The health complex provides consults in general medicine, vision care, dentistry, gynecology, educational seminars, and counseling. BRA plans to equip the center in the future with diagnostic equipment including an electrocardiogram and x-ray scanner. An ambulance is already available to provide emergency transport services.
The Health Center has seen 16,793 patients since January 2006. The Center also saw 96 patients for Papanicolaou. The following demographics were served at Cinco Casas:
Table 3. Cinco Casas Patients
Patient Group No. of Patients
Boys (0-10) 2,835
Girls (0-10) 4,350
Adolescent Boys (11-18) 2,008
Adolescent Girls (11-18) 1,500
Men 2,400
Women 3,700
Total 16,793
C. COMPREHSNSIVE HIV/AIDS INTERVENTION
HIV/AIDS IN THE BATEYES
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 socio-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 mission to provide community-based health care as well as education and social services inside the bateyes underlies its HIV/AIDS intervention—the concept of bringing the care home to the population.
HUMANITARIAN HIV/AIDS CARE
Since 2004, BRA has brought life-saving resources to HIV-positive people in the bateyes. Science Magazine in its August 2006 Internet report recognized BRA’s HIV/AIDS program as one of the most innovative in the Dominican Republic. BRA offers free comprehensive health care to AIDS patients inside its Cinco Casas’ Center, including antiretroviral therapy and treatment for opportunistic infections. BRA also offers a cadre of social services including psychological support, economic assistance, nutritional aid, vocational training, education, and HIV counseling and testing at our mobile clinic and health center. Currently, there are 250 adults and 33 children living with HIV/AIDS enrolled in BRA’s program, as well as 1026 family members. BRA has 59 patients who receive antiretroviral treatment directly from BRA at the health center and has conducted 66 CD4 tests. A number of BRA’s patients continue to receive their treatment from other sites in the country and seek medical care and other services from BRA.
THE AIDS PATIENT FUND
In February 2006, BRA received over $22,000 in donations to establish the AIDS Patient Fund through the Dessalinian efforts of one of its full-time volunteers, Morgan Chessia. BRA is uniquely able to assess the needs of HIV/AIDS patients living in the bateyes through monthly check-ups at our clinic and health center and through regular home visits. BRA decides on a case-by-case basis what types of support each patient needs in order to distribute this fund as equitably as possible. The goal of this fund is to enable our patients to access the free antiretroviral drugs provided by the government, through the support of the CHAI that is now available at a few sites in the country, including BRA’s health center since May ’06. The AIDS Patient Fund covers costs associated with:
· Transportation
Many of BRA’s patients live in bateyes that are isolated and not generally serviced by public transportation. The cost of transportation from patient’s homes to our clinic, health center, or to the capital is prohibitively expensive and can discourage or prevent patients from receiving the health care and treatment they need. Many of our Haitian and Haitian-Dominican patients also fear discrimination because of their ethnic background or because they are too sick to seek care on their own. In these situations, the AIDS Patient Fund also covers accompaniment for these patients to health care services.
· Testing
Even in the public hospitals, patients must pay for their own laboratory tests. The AIDS Patient Fund covers the cadre of tests necessary for our critically ill patients to initiate antiretroviral treatment, including the CD4 tests and to properly treat opportunistic infections.
· Essential Medicines
BRA’s clinic provides primary healthcare and free medicines Monday through Friday. When the clinic does not have the necessary medicines to treat AIDS-associated opportunistic infections, the AIDS Patient Fund is used to purchase these medicines. Many AIDS-associated illnesses are expensive to cure. Having this fund available means that uncomfortable conditions like Shingles or Chancroid won’t be left untreated.
· Nutritional Aid
Lack of access to food is a major problem in the bateyes. This is especially a concern for AIDS patients who lose weight rapidly in the later stages of their illness. While administering the ARV treatment will certainly help fight many infections associated with AIDS, but if the patients do not have access to healthy food while undergoing their treatment, they will die. Moreover, as they become weak and physically unfit to work, they cannot produce for themselves, their families and their community. The AIDS Patient Fund is used to supplement the diets of these patients with symptoms of wasting until they recover enough to be self-sufficient with the help of antiretroviral drugs. Thirty (30) families have received food ration from the BRA, of that number there are 30 persons living with AIDS, 155 vulnerable/affected children, 65 men and women affected, a total of 250 beneficiaries. It is our goal that once BRA has helped stabilized the patients’ physical, mental and health state; they can then go back to work and produce for their communities and families. The Disciples of Christ’s Week of Compassion also supports the program.
THE CHAI—ANTIRETROVIRAL TREATMENT IN BATEY CINCO CASAS
In May, BRA began offering antiretroviral treatment—ARV directly to patients at its health center in Batey Cinco Casas—the first time ever this type of treatment is being administered to Batey AIDS sufferers inside their own communities. In collaboration with the CHAI and the Dominican Ministry of Health’s DIGECITTS, the life-saving program also provides a pediatric AIDS specialist, Consuelo Beckett and a psychologist, Matilde Marcia Contreras. BRA’S AIDS patients visit the health center every 15 days for treatment and medical attention. In addition to the ARVs, each patient receives protein, vitamins, and prophylaxis against opportunistic infections. Our patients have lab work including the CD4 count—a measure of the body’s immune system that is essential for initiating and monitoring antiretroviral treatment, done free at the health center.
HIV/AIDS PREVENTION AND EDUCATION— MOTHER/CHILD HEALTH AND PREVENTION of VERTICAL TRANSMISSION PROJECT
From August to December 2005, BRA extended its infant health and prevention of mother-to-child transmission of HIV project, which began in 2004. This project, funded through the Canadian Embassy’s “Fondo Canadiense para Iniciativas Locales” (FCIL), trains BRA’s local health promoters and 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.
Over the course of the project, 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 (STDs). The seminars were given in Batey Cojobal and in Monte Plata for the health staff of the BRA, and 13 people attended these training sessions. In addition to these training sessions, BRA provided 2 educational seminars for 41 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 1378 people through “mobile clinics” opened within each community. This included 378 women, 534 girls, 428 boys, and 38 men. 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 147 women received pap smears.
An important long-term effect of this project was to increase awareness of mother-to-child transmission of HIV/AIDS in the bateyes. Since the project ended in December 2005, we have had three HIV positive mothers enroll in our HIV/AIDS program. Each took the proper precautions to prevent HIV infection of their child. Each received antiretroviral medicines at the time of birth from a public hospital, one underwent a caesarian, and all three exclusively fed their infants formula.
“RAINBOW” HIV/AIDS PROJECT FOR COMMUNITY SUPPORT OF AIDS PATIENTS
BRA also provided community support and home care through a yearlong project funded by USAID and Family Health International in 2005. Through this project, called the Rainbow—Arco Iris project, BRA has worked to identify HIV-positive people by teaching about HIV/AIDS prevention and treatment in schools and churches and encouraging them to come and get tested at our health facilities. From August 2005-July 2006, BRA conducted 40 educational sessions in the bateyes of Monte Plata. During this time, BRA also conducted more than 2,000 home visits where program staff had the opportunity to individually evaluate the health of each patient and provide them with donated personal hygiene materials. BRA has also worked to unite and empower individuals affected by HIV/AIDS through workshops for patients and their families. BRA conducted 5 workshops for HIV/AIDS patients and their families teaching them how to protect their health. Some of the topics covered in this workshop included: self-esteem, drug and alcohol abuse, nutrition, hygiene, and exercise. BRA also conducted 18 vocational trainings. Many of our AIDS patients are among the most destitute in their communities, thus providing them with tools to earn an income is essential to improving their health and economic independence—thus working towards human productivity and dignity. This project will continue through May 2007.
MARGARET SANGER CENTER INTERNATIONAL HIV/AIDS/VIOLENCE PROJECT
This project, funded by the MAC AIDS Funds, sought to prevent violence and educate people about the connection between HIV/AIDS and violence. Violence, especially against women and children, is deeply connected to HIV/AIDS. Rape and sexual abuse is a known cause of infection among some of our HIV/AIDS patients. Violence in a relationship can preclude negotiating safe sex and prevent family members from seeking and/or receiving medical care, also problems we have experienced first hand in our patient population.
To reduce violence and educate people about its relationship to HIV/AIDS, BRA conducted two workshops with thirty-five youths and health promoters. The first workshop taught about the forms of HIV transmission, the causes and consequences of HIV/AIDS among youth, the effects of stigma and discrimination on people living with HIV/AIDS, and how to prevent stigma and discrimination. The second workshop dealt specifically with the influence of violence on sexual and reproductive health and strategies to promote equality among the sexes.
BRA also conducted a workshop in July specifically for health its personnel about violence against women and its connection with HIV/AIDS. By the end of this year, BRA will also have conducted 12 educational sessions reaching at least 500 men and women about violence against women and its relationship with HIV/AIDS. Already 188 people have benefited from these sessions.
“ALIANZA DE BATEYES-BATEY ALLIANCE” YOUTH HIV/AIDS EDUCATION
This year, BRA is organizing and training networks of young people to prevents HIV/AIDS in their communities. This project is part of the National Program Against HIV/AIDS with funding from the United Nations Global Fund for AIDS, Tuberculosis, and Malaria. Six bateyes will be the beneficiaries of this project: Batey Cojobal, Las Taranjas, Juan Sanchez, El Bosque, La Cerca, y La Fria. BRA will be recruiting and training group leaders and HIV/AIDS counselors, developing educational activities, facilitating group leaders in organizing and training groups of young people, monitoring and evaluating the activities of the youth networks, and promoting and offering HIV counseling and testing. The Project is supported by the Dominican Republic’s COPRESIDA.
BEHAVIOR CHANGE AND SOCIAL MARKETING OF CONDOMS WITH POPULATION SERVICES INTERNATIONAL (PSI)
This year BRA began working on a 20-month project with PSI to reduce the incidence of sexually transmitted infections including HIV in the bateyes through behavior change and the social marketing of condoms. The project has two central strategies: 1) Social marketing of condoms. This project will make high-quality condoms available to local vendors at a subsidized price. By requiring customers to pay a nominal payment for condoms, the project aims to impart a sense of value in the decision to purchase and use a condom. By selling the condoms, the project also supports the local economy and contributed to the sustainability of condom sales in these communities. 2) Education. PSI will launch a communication campaign focusing on behavior change in adults aged 20-49. Specifically, to reduce the number of sexual partners among and increase the correct and consistent usage of condoms in this age group. A secondary objective of this project is to create a sense of cooperation between bateyes that although geographically dispersed, share similar characteristics and challenges. By creating a common bond among these communities through this project PSI/BRA hope to increase solidarity at the national level and contribute to a process of economic and social empowerment to generally improve the situation of the bateyes within the Dominican Republic.
PREVENTIVE HIV/AIDS EDUCATION – NEW YORK
BRA received one-year funding from the New York State Department of Health, through the office of Assemblywoman Rhoda Jacobs, to carry out radio shows addressing HIV/AIDS among low-income and ill-educated immigrant communities of Yew York. The program was implemented with the collaboration of Brooklyn-based Radio Soleil.
C. TUBERCULOSIS INTERVENTION
In conjunction with USAID’s Project CONECTA and the Dominican Republic’s National Tuberculosis Control Program, BRA initiated a nationwide program to control tuberculosis inside the Dominican Republic’s bateyes. This project, which began in August 2005, has trained a network of 220 community health promoters in 62 bateyes in the province of Monte Plata to identify patients showing signs of tuberculosis and refer them for testing. So far BRA has referred 174 patients to hospitals in Monte Plata since August 2005. Now, with the recent donation of a motorcycle from USAID, Ignacio “PAPO” Pierre, the supervisor of the TB program and one of BRA’s key promoters, is able to collect sputum samples directly from patients in the bateyes surrounding Sabana Grande de Boyá and bring them to the hospital preventing them from having to travel. BRA is responsible for a large percentage of TB referrals in the state of Monte Plata.
Table 4. Respiratory Symptoms in the Hospitals of Monte Plata (Jan 2006-Jun 2006)
Hospital # Referred # Referred by BRA % Referred by BRA
Monte Plata 96 28 0.29
Sabana Grande de Boyá 92 32 0.35
Yamasa 46 11 0.24
Don Juan 4 4 1.00
Total 238 75 0.32
Table shows BRA made about a third of all referrals between January and June 2006.
Those who test positive are referred for treatment with directly observed therapy. This past year, 4 BRA patients were treated for TB: two were cured and two are currently receiving treatment. None of BRA’s patients have abandoned their treatment regimens.
The local health promoters also give educational seminars in their respective bateyes on the identification and treatment of tuberculosis. This year promotoras have offered 63 such seminars. These have included 4,425 people. Informational materials were also distributed to 6,867 people. In addition to identifying cases and educating rural communities, BRA has provided support to patients and their families through 58 home visits and 5 families have received food donations.
E. BLINDNESS PREVENTION
This year, BRA’s Blindness Prevention Program continued to provide complete eye exams, eyeglasses, eye drops, and medicines to patients in the Mobile Clinic and began offering vision care in Cinco Casas. Over 800 pairs of glasses were distributed to patients. The following demographic groups were represented at the Mobile Clinic:
Table 5. Vision Consultations Mobile Clinic
Patient Group No. of Patients
Boys (0-10) 18
Girls (0-10) 14
Men 208
Women 339
Total 579
This year, BRA began offering vision care at the Health Center in Cinco Casas and 475 patients have received vision consultations. There continues to be a great need for surgical missions to correct pterigiums, cataracts, and strabismus.
F. WATER PROJECTS
BIOSAND WATER FILTERS
This year, BRA will distribute 60 Biosand Water Filters to families in Batey Cojobal and to HIV/AIDS patients in bateyes surrounding Sabana Grande de Boya. Already, 10 of BRA’s HIV/AIDS patients have received emergency filters. This project is sponsored by the Rotary Club of New York, Rotary Club of Wallkill Valley, and the Club Rotario Arroyo Hondo Santo Domingo.
Access to clean water/sanitation for Batey residents is a major institutional goal for BRA, a grave concern in the bateyes, and a major source of illness in our patient population. With no potable water available, most batey residents rely on rivers, rain, or open wells as a source of water—all of which contain water-borne pathogens. In recent focus groups conducted by BRA, batey residents listed clean water as their number one priority. Based on BRA’s current statistics, 14% of patients who visit the Mobile Clinic in Batey Cojobal are seeking treatment for intestinal parasitic infections. Parasitic infections are a common cause of death in children under five and can also contribute to anemia and other health problems. Imagine being constantly plagued by gastrointestinal pain, vomiting and diarrhea. This is the reality for people without access to clean water. While BRA has been treating water-borne illnesses for years at their health facilities, this initiative gets to the root of the problem, preventing people from getting these infections and reducing their spread within the community. Next year, BRA hopes to expand this project to other bateyes in Monte Plata, providing clean water—a basic human right for all.
BRA’s model water filtration project will benefit over 200 families. Each family that receives a filter also learns about health and hygiene and how to care for their filters. BRA also trained community stewards to provide continued education and support for filter users.
Access to clean water is especially more problematic among HIV/AIDS patients who do not have a hardy immune system to defend themselves against water-borne pathogens. Infection with multiple parasites is very common among these patients and can begin a downward spiral of weight loss that eventually leads to death. Not only will these filters impact the health of these patients directly, it will also improve the health of the family members caring for these patients and their immediate neighbors and reduce local transmission of water-borne pathogens to these patients.
Last August, 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 years living in the bateyes of Monte Plata where families are often too poor to buy shoes for their children. Because they don’t have shoes to protect their feet, these children contract parasites and skin infections. The beneficiaries of this project will receive the shoes and learn about the importance of wearing them and their capacity to prevent disease.
PUR WATER PURIFICATION TABLETS
As another approach to dealing with the water/health crisis in the bateyes, BRA is partnering with PSI to distribute affordable PUR water purification tablets, a product of Procter & Gamble. One PUR tablet costs 5 pesos or about 20 cents and will disinfect 2.5 gallons of water. BRA and PSI are working with local businesses, HIV/AIDS patients and health promoters to sell the tablets and to educate people in the bateyes about how to use them. This will provide a much-needed income for these individuals while promoting access to clean water and hygiene education.
G. VOLUNTEERS AND MISSIONS
As part of its humanitarian health intervention inside the Dominican Republic, BRA mobilizes experienced volunteer health care providers and medical students from the United States and Canada to work alongside their Dominican counterparts at its health facilities and on mission trips. BRA also places volunteers at some of its partner organizations’ health facilities. This year, 41 volunteers traveled to the Dominican Republic to work with BRA in medicine, public health and administration. Local health professionals share their expertise with the visitors who do the same from a western healthcare point of view.
APRIL MEDICAL MISSION TRIP
In addition to its permanent healthcare programs, BRA also sponsors short-term volunteer medical, dental, and eye care missions to the Dominican Republic, on which volunteers from North America 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. Follow-up care is provided by BRA after the missions end. In April, BRA received a group of 14 volunteers from the US-based Association of Haitian Physician Abroad—AMHE, including two dentists, three dental assistants, two pediatricians, an internist, a medical assistant, and five medical students. This mission served a total of 1,010 persons including 397 children and 613 adults. This population included people from 24 bateyes and 3 rural communities and 2 cities with 93% of the patients from bateyes.
HAÏTI-LÉVIS FRIENDSHIP MISSION
From May 22 to June 6, a group of 14 young people from Canada’s Quebec with the “Haïti-Lévis Friendship Mission” volunteered in Batey Cinco Casas. The group conducted educational sessions for young people and adults and created a playground for children at BRA’s Health Center.
LONG-TERM VOLUNTEERS
This year, BRA had 14 long-term volunteers who spent a month or more working at its health facilities in Cojobal and Cinco Casas. They are professional physicians, medical students/residents, and non-health volunteers.
Medicine: Alan Kerr, Jacinthe Bordeleau, Jade Theriault, Yaron Friedman, Eric Echenfeld, Marie-Anne Gagnon, Yann Tissier, and Philippe Chouinard.
Public Health and Administration: Chitra Akileswaran, Naira Arrellano, Morgan Chessia, Colleen Reinert, Jessie Clyde, and Rhett Massey.
III. PARTNERSHIPS AND MEMBERSHIPS
ASSOCIATION WITH THE UN’S DEPARTMENT OF PUBLIC INFORMATION
On 7 July 2006, the Committee on Non-Governmental Organizations of the Department of Public Information (DPI) at the United Nations approved the Batey Relief Alliance (BRA) for association with the Department. The association constitutes a commitment on the part of the BRA to disseminate information and raise public awareness about the purposes and activities of the United Nations and issues of global concern. Associated NGOs, like BRA, are expected to focus a portion of their publications and information activities on the work of the United Nations. As an associated NGO, BRA is entitled to designate a representative, who will be granted a UN photo grounds pass. The pass will give the representative access to the UN facilities and to all open meetings of the UN bodies, which he/she can attend as an observer. BRA’s representative will also be invited to attend Thursday NGO briefings organized by the Department, featuring high-level UN officials, government delegates and other experts, including NGOs. BRA’s representative will be allowed to consult UN print, audio and video materials at the NGO resource Centre. BRA will receive monthly mailings of relevant UN materials and information on UN conferences, seminars, briefings and other events.
BRA also received the new partnership of the Columbia University’s Mailman School of Public Health, through the Dominican Exchange Program, providing the organization with a Public Health student to conduct in August health service surveys of its medical facilities. The results will help BRA study and evaluate its patient/service relationship, and enhance its humanitarian health intervention inside the Dominican Republic.
LOCAL MEMBERSHIP
This year, BRA DOMINICANA joined the memberships of the Dominican-based Alianza de Bateyes and the ONG-SIDA. These two groups provide a platform for collective lobbying on and community services for health-related issues.
MEDICAL DONATIONS: ALLIANCE ORGANIZATIONS
As part of its humanitarian health care expansion in the Dominican Republic, BRA also distributes donated medicines and medical supplies to partners of its Dominican-based Alliance working to provide health care in impoverished bateyes, urban slums, and rural communities where the population cannot afford basic medical care. 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 donated medicines, beds, milk, and materials to 18 public and non-profit organizations.
Table 6. Donations to BRA’s Partners
Organization Type of Donation
Colectivo de Salud Popular Medicines, materials
Fundacion Todo por la Salud Medicines, materials
Servicio Social de Iglesias Dominicanas Medicines, materials
Alas de Igualdad Medicines, materials
Consejo Estatal del Azucar Medicines, materials
Dirección Provincial de Salud de Monte Plata Medicines, materials
Dirección General de Control de ITS y SIDA Medicines, materials
Fundacion Amparo Infantil Medicines, materials, milk
Club de Leones Santo Domingo Arroyo Hondo Medicines, materials
Hogar de Ancianos San Francisco de Asis Medicines, materials
Hospital Provincial de Monte Plata Medicines, materials
Hospital Municipal de Sabana Grande de Boya Medicines, materials
Clínica Rural Districto Municipal Don Juan Medicines, materials
Clínica Rural El Cacique Medicines, materials
Clínica Rural de Villa Jaragua Medicines, beds, materials
Clínica Rural de las Clavellinas Medicines, beds, materials
Clínica de Rural Postrer Rio Medicines, beds, materials
Fundacion Genesis Medicines, materials
Approximately 40,000 persons have been served as a result of BRA’s donations.
IV. SUPPORT FOR BRA’S WORK IN 2005-2006
IN-KIND DONATIONS OF MEDICAL SUPPLIES AND MATERIALS
BRA continues to provide free medicines and glasses and low-cost medical services to its patients. It does so by soliciting donations of medicines, medical supplies and equipment from the United States and Canada. Between August 2005 and July 2006, BRA received US $6.287,907.43 worth of medicines, supplies and equipment for its humanitarian health care operation in the Dominican Republic.
BRA’S FINANCIAL ANNUAL REPORT
A copy of BRA’s latest annual financial report may be obtained from the Office of the Attorney General, Charities Bureau, 120 Broadway, New York, N.Y. 10271.
WHO SUPPORTED BRA’S WORK IN 2006
The Bill Clinton Foundation’s HIV/AIDS Initiatives, Lions Clubs International Foundation, St. Joseph Hospital Exempla Foundation, Google Grant Program, New Jersey Lions Eyeglass Recycling Center, Wallkill Valley Rotary Club, New York Rotary Club, Club Rotario Arroyo Hondo Santo Domingo, USAID/CONECTA/Family Health International, Columbia University’s Mailman School of Public Health, Catholic Medical Mission Board, Direct Relief International, Food for the Poor, Church World Service, Disciples of Christ’s Week of Compassion, Interchurch Medical Assistance, Dominican’s Ministry of Health (SESPAS), First Congressional Church of Albany New York, the New York State Department of Health (Assemblywoman Rhoda Jacobs), Washington-DC Order of Malta, and a number of generous individual donors.
V. INTERNET UPDATE OF BRA’S HEALTH CARE INTERVENTION
It is of great importance that we keep you up-to-date with our work by visiting BRA’s website at www.bateyrelief.org.
VI. CHALLENGES
1. Increased Financial Independence (IFI)
BRA does not have major sponsors to support its program expenses. BRA only relies on limited financial support from its board of directors, a number of organizations, the church and individual donors to carry out the many ambitious projects it undertakes. A high percentage of the organization’s total budget covers project delivery operation. BRA’s operation is generally under-funded. As BRA grows steadily into a well-developed institution and undertakes large-scale projects, it is crucial that we receive enough funding to develop a professional and capable operating staff.
BRA is often forced to rely on project-funding organizations to contribute almost the entire operating budgets to the projects. This limits BRA’s ability to design and carry out projects as it sees fit. 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 in the Dominican Republic.
The following specific needs could be addressed by an increase in funding:
· Improved operation of BRA’s health care facilities: as patient visits increase, BRA must increase its health personnel and supplies of medicines to meet increased patients’ health needs.
· Energy: BRA’s health center is fully equipped with equipment to deliver care. But there is very limited supply of energy to power the equipment. BRA needs funds to install inverters and generators to receive permanent electricity.
· Transportation costs for patients: many patients that cannot be treated directly through BRA’s health centers go untreated because they lack the money to travel to other sites for essential, and at times, free treatment. Many patients 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. Funding organizations often neglect to provide BRA projects with sufficient transportation budgets.
2. Increase Organizational Capacity
BRA lacks the organizational capacity to keep up with its fast-growing projects and the number of people in need of health care assistance in the bateyes. Our staff is limited in number and in expertise. We need to improve our capacity in order to perform adequately. Funding support in workforce development is urgently needed.
3. Increase Support Capacity
BRA’s two health facilities service a population of approximately 25,000 annually. More than 70% of the patients are too poor to afford basic medicines. While the number of our patients 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.
4. Increase Support for HIV/AIDS Intervention
It is imperative that partner institutions that work with BRA to implement our HIV/AIDS treatment program do understand the need to put funds aside for the transportation and nutrition of the patients. The lack or absence of healthy nutrition perhaps is our greatest barrier for the effectiveness of the ARV treatment. Our patients simply cannot undergo their treatment without food in their stomach. It does not help to only implement the program entirely on testing, treatment and prevention, while ignoring other key factors, such as food, that could be detrimental to the effectiveness of the program. Healthy food + ARV treatment = Healthier patients. They go hand in hand. The lack of funds to transport patients to clinics to receive their life-saving treatment is also a serious problem.
5. Increase mobile clinic’s space capacity
Since the installation of the mobile clinic at Batey Cojobal in 2003, the demand for health care has increased tremendously. The clinic, as a result, has become too small to accommodate all of our personnel working at one time and the increased number of patients. There is no waiting area for patients to protect against heavy rains or the burning sun. The clinic’s limited space (one consultation room and a waiting room) has often challenged patients’ privacy and visits. BRA loses each month a great percentage of patients who return home uncared for as the waiting time is hours long. BRA seeks to expand the clinic’s space capacity by building an expansion ward to facilitate a proper health care environment. The new ward will be built with separate consultation rooms for general medicines, pediatrics, HIV/AIDS testing and counseling, and areas for reception/registration, data collection and filing and waiting.
VII. THE FUTURE
The BRA endeavors to undertake and implement the following programs and projects:
§ Build an expansion medical ward for the mobile health clinic
§ Multivitamin & Deworming for 55,000 children
§ Residential Home for HIV/AIDS children
§ Music and Arts for children
§ Water/sanitation for AIDS sufferers and Batey families
Haiti:
The BRA will again study the possibility of establishing a permanent humanitarian mission in Haiti. Due to past political instability, the project had to be put on hold.
VIII. THANK YOU
The Batey Relief Alliance and BRA Dominicana and our Boards of Directors are thankful for your support enabling us to do important work on behalf of the poor. You are the partners we depend on to serve those in desperate need. There is much more to be done. And we need your continued assistance. We look forward to a productive partnership with you in the years to come.
Respectfully,
Ulrick Gaillard, J.D., CEO
