During the summer of 2015, I spent time conducting community based research in the Dominican Republic. The people I met and the stories I heard throughout my fieldwork brought what I had learned in my classes to life. As part of my Spanish minor, I was exposed to many lectures and even an entire course focused on how economic disparities, lack of opportunity, inadequate healthcare, and poor education, contributed to the increasing emigration of Hispanic peoples. Together, both my research and classes helped transform my perspective on Spanish immigrants and their impact on healthcare.

 

In the course, Working with Hispanic Clients, our largest focus quickly became immigration in the United States. Specifically, we explored the complex social, economic, and political factors that cause immigrants to leave everything behind in pursuit of opportunity. We discussed that one of the largest incentives for immigrants is an economic one. In many countries educational resources are sparse. People will drop out of school early to find work and contribute to the family income. Even those who finish school might not be able to find work at all. The fact is many Hispanic immigrants come to the United States because economic opportunity can be extremely limited in their countries. One class reading illustrated just how quickly the hispanic population in America was growing.

 

Once here, often all they find are strenuous jobs that require long hours. The wages are low, but the unfortunate truth is that they are likely making more than they ever could have back home. In order to save money, men will often live together in community housing, sharing commodities such as meals and sleeping quarters. Whatever money can be saved is likely sent back home to idle families with no means of generating income.

 

Despite my lessons, the extent of these peoples’ economic plight wasn’t really concretized for me until I analyzed data gathered during my research in the Dominican Republic. I could now quantitatively observe just how little opportunity these people have. Of the participants in my study,

37% reported having no household income whatsoever. An

additional 45% claimed to be earning less than about $200

USD per month. That is 82% of interviewees (most of whom

have families) living on less than $7 USD per day.

Furthermore, one out of every three subjects dropped out of

school before beginning their secondary education. These

statistics, among others I collected (shown on right), really put

into perspective just how scarce economic and educational

resources can be in Latin America. It was starting to become

clear to me why immigrants to the United States put themselves

through all the discrimination and hardship only to work such

arduous and low-paying jobs.

 

In addition to the numbers, two moments in the Dominican Republic really transformed my outlook to what it is today. The first was seeing Hospital Ricardo Limardo, the largest and most sophisticated hospital in province of Puerto Plata. The rooms all contained 10 – 15 beds, most of which were full. In addition to the patients, families were gathered around daughters who were hours away from giving birth and sons fresh out of surgery. A single hallway connected the crowded rooms. Instead of windows, a chain linked fence exposed the ward to the elements and insects while keeping birds and larger animals out. In class I had learned that many governments struggle to provide their people with necessary infrastructure such as healthcare facilities. It wasn’t until I saw things with my own eyes did I realize what a drastically different lifestyle these people lived.

 

The second impactful experience was my first walk through a batey. Bateyes were the housing communities built for workers of the sugar cane plantations that once populated much of the island. Despite many plantations no longer functioning, families continue to live in the original concrete shanties. I will never forget what I saw.

 

Old sheets separated makeshift rooms, with as many as 5 people sharing a space smaller than a two-car garage. Rooms included a “kitchen”, “bathroom”, and “sleeping quarters”. I met an old man who couldn’t leave his home, because his diabetic ulcers confined him to his wheelchair. He depended on another American student to appear periodically to change his bandages and purchase and deliver medication. I befriended a four year old with a developmental disorder who was abandoned by his mother. I also met the neighbor with a large heart who happily took him in, despite having her own family to provide for.

 

None of the films I watched in class or articles I read for homework had captured what I saw with my own eyes. These experiences finally humanized the concept of immigration. They make sacrifices and work tirelessly to provide for families overseas so maybe one day they too can have a better life.

 

My research complimented the lessons learned in my classes and solidified a desire to work with underserved populations both domestically and abroad. I also realized that understanding their cultural differences and backgrounds would be critical to successfully delivering care. Language and cultural barriers may prevent patients from seeking care in the first place. If they do come for treatment, I must know how these differences might affect their openness in sharing their medical history and how well they follow my medical recomendations. There is no doubt in my mind immigrants and their families deserve the same rights we do, especially the right to health. Four years ago, I would never have imagined how much my career aspirations would revolve around this newly formed belief. Everyone deserves to be cared for, and my goal as a physician will be to make that happen.