room for paradoxes

My research is in its final phase. A few months ago, it seemed as though the day I’d be able to say that would never come. And I certainly had no idea back then what this final phase would look like.

I’ll start by redefining what my research has been, since it has evolved so much since I wrote that initial proposal in July 2008. Essentially, I’ve been examining foreign aid aimed at tackling health issues in the Dominican Republic, focusing on the U.S. Agency for International Development (USAID) and the Global Fund for AIDS, Tuberculosis, and Malaria as the sources of funding under scrutiny. Within health issues, I’ve chosen to focus on tuberculosis as a case study, mostly because of my gender focus and the fact that the gender aspects of TB are sorely under-researched.

The case study has consisted of tracing aid money from the halls of Congress to service delivery at the community level. I have interviewed staff members at USAID, non-governmental organizations (NGOs) that receive USAID and Global Fund money for TB programming, and I have taken a close look at one of the sites of implementation of intervention programs – an urban clinic in Santo Domingo.

At the clinic, my methodology has consisted of participant observation, open-ended interviews, and informal conversations with personnel and TB patients alike. The aim has been to gather qualitative data on a variety of aspects of TB patient experience and care in order to 1) determine what, if any, differences and disparities exist between female and male patients, and 2) understand how foreign aid can be improved and complemented with policy changes at the international, DR national, and local levels.

So where am I now? Data analysis, data analysis, data analysis. Qualitative data is tricky, to say the least. Although Fulbright demands no final product (other than general midterm and final reports we have to turn in), I would like to write a report in English and Spanish that can be utilized by everyone who has helped me along the way – from USAID staffers to local care providers – and possibly another, academically publishable document outlining some of the issues I’ve found, aimed at the global public health community.

Since data analysis can be a very solitary and home-based activity, my Tribe spirit of service and community engagement has been restless of late. Consequently, I have started volunteering at a local alternative school for children with special needs, including Down’s syndrome, epilepsy, deafness, autism, learning and physical disabilities, etc. So far this means pouring cups of water, handing out colored pencils, and producing commissioned clay animals. But I would like to see my medical school get involved with this place, because the university where I am going has a wonderful institute for global health and a graduate school of education with a center focused on human development and research/service for people with special needs. So volunteering and trying to establish some sort of sustainable partnership is my new project.

While I am excited about the prospect of med school in a few short months, I also can’t help but have mixed feelings about returning to academia. I feel like I am truly living one of my dreams – to learn about patient experiences in order to advocate at all levels for health programming and foreign policies to reflect the human right to health. While I will probably be able to do this much more effectively once I am a doctor, I can’t help but wince at the thought of returning to a library-based lifestyle in a social environment that people have often described to me as similar to middle school. I think I’d rather hang out in bateyes and spend my time talking to tuberculosis patients in the urban clinics of Santo Domingo, heading to Caribbean beaches on the weekends, writing and reading in my apartment by the sea, eating fresh tropical fruit on a daily basis, and practicing my Haitian kreyol whenever I can. Ok fine, fine, I’m going to miss this place. I admit it. This is where the Maxine Hong Kingston quote to the right comes in; those words seem to define a lot for me lately.