el país de la maravilla, part 2

After resting in Santo Domingo, Celeste and I were on the road again at 7:45am – this time to visit some friends in Batey Libertad and to watch a soccer game. The batey is home to a few good friends of mine and is the main field site of another Fulbrighter. It was lovely to finally see a community I’d heard so much about, meet the families of close friends, listen to the musical sounds of Sunday morning church while visiting the local voudou space, and hear both Dominican bachata and Haitain compas competing from colmado speakers. It was also a great opportunity to practice my Kreyòspañol :)

After a Haitian lunch, we piled into a guagua – Celeste, my fellow Fulbrighter, a Peace Corps friend, the soccer team, coaches/supporters, and me. There were 21 of us in the van. The game was to be held in Santiago, a city about an hour down the road from the batey. When you drive eastward in the DR, though, you’re bound to hit military checkpoints. Ostensibly looking for “illegal Haitian immigrants,” they are convenient opportunities for local officials to pocket some bribed cash and enforce the unofficial Dominican policy of racism towards Haitians – or, really, anyone with dark skin.

We were stopped at two or three checkpoints; needless to say, our vehicle filled to twice its capacity of passengers, most of them dark-skinned, was suspicious – or perhaps auspicious – to bored Dominican military personnel on a Sunday afternoon.

“Morenos, huh?” said one of the soldiers, peering into the vehicle (morenos means “dark-skinned/featured”). “Tígueres” (gangsters, hoodlums). Then of course there were questions about the couple of obvious foreigners mixed in with all the Haitian gangsters. I kept my mouth shut, glowering, and the cops seemed to assume I was either Haitian or Dominican. And then there was the obligatory side conversation between the driver and the cops, and then the few hundred pesos passed along (“we aren’t going to ask for money, but if any of the foreigners would like to make a donation…”), and then we were on our way.

Such incidents never fail to make my blood boil. But we made it to Santiago with only one person getting arrested (in the other vehicle, a Haitian-Dominican unlucky enough not to have his papers on him; he was later released). "We've arrived in South Africa!" shouted one team member as we poured out of the van.

The game was great, though Celeste and I missed all the buses back to Santo Domingo except one. Not the best of bus companies, it dumped us off on a random street corner in the capital close to midnight. Luckily there was a handful of other passengers, with whom we huddled for protection until a taxi arrived to take us home.

El país de la maravilla never disappoints.

el país de la maravilla, part 1

A friend here once told me that the reason that the DR is known as “el país de la maravilla” (the country of wonder) isn’t its beautiful beaches or breathtaking countryside. It’s because there are just some things you see here that you won’t see anywhere else.

Last week my best friend Celeste came to visit me. Our lives – or perhaps better described as “life,” since we are technically two halves of the same person – have often been referred to (by us) as the Adventures of Irène and Celeste. Our adventures have taken place everywhere from the hallways of a public high school to the floors of university frat parties to the sands of the Outer Banks…and now, for the first time, they took place in the Dominican Republic.

My grand plan for Celeste’s visit was to hike Pico Duarte with her – something I’d been meaning to do during my time here. A friend of a family friend recommended our guide, Julio, who agreed to pick us up at the Jarabacoa bus stop on Wednesday afternoon. When we got off the bus, of course, more people than were getting off the bus crowded the door, asking if we wanted a ride or a guide to Pico Duarte. I looked around for Julio, who quickly stepped forward and introduced himself (I’d told him to look for two tall gringas with backpacks). Julio led us to the flatbed truck that would take us from Jarabacoa to the small town of la Cienaga, his home and the starting point for Pico Duarte hikes. Julio was accompanied by a small band of men whose purpose was unspecified(Julio groupies?). Celeste and I dubbed them “J’s boys,” and they reappeared periodically throughout the next several days. Very West Side Story.

Julio took me aside a few times to ask, “do you know about Pico Duarte?” I said that I’d heard a few things. “Because it’s hard, really hard.” He gave us a look. I told him that I’d done the Inca Trail and that Celeste had spent a week hiking in Appalachia the previous summer, but Julio didn’t seem impressed. “This isn’t the Inca Trail,” he warned. “This is Pico Duarte.”

The flatbed truck took us to buy food at a super-colmado that smelled, according to Celeste, like a toilet. (I’ve become immune to the sometimes pungent scent of colmados.) We stocked up on rice, beans, canned veggies, bread, cheese, yogurt, and canned ravioli to eat along the trail. Then we made the hour-long, rainy, bachata’d ride through the mountains to la Cienaga. J’s boys sat in the back of the truck, protecting our backpacks from the rain and passing around a bottle of liquor in plastic bag. They kept offering it to us, but we refused.

When we finally reached Julio’s, we were served two dinners within the span of an hour. If it wasn’t already clear, we now understood perfectly that he doubted our strength. J’s boys wandered back in between the first and second dinner, still nursing their bottle of liquor (with increasingly long swigs) and still offering it to us. We politely continued to refuse and busied ourselves with a second mountain of chicken and rice prepared by Julio’s wife.

The next morning, Julio woke us up, muttering that we’d slept in. We had been under the impression that he would wake us up when the time came, but apparently this impression was false. We packed up and headed out into the mountainous Dominican sunrise with our two trusty mules. We insisted on carrying our backpacks, which further contributed to Julio’s conception of us as silly, misguided gringas. “That’s what the mules are for,” he said, giving us his judging stare (he wore his judging stare for at least 60% of the trip). We weren’t sure how to explain why we wanted to carry 35-lb. backpacks up a mountain, so we just smiled and refused.

We made it pretty far before we had to give in and put our backpacks on the mules. It was somewhere around 1,900 meters when we realized that “hiking” Pico Duarte meant death by ascension. We went up and uP and UP and it never stopped. The trail seemed to be designed not for human hikers, but rather for, well, beasts of burden. Julio mostly rode one of the mules. When Celeste couldn’t take it anymore, she switched places with him, but when I tried to ride the other (the one already carrying all of our belongings and supplies), mutiny ensued (or, as Celeste put it, “mul-tiny,” if you will). Because I felt bad for the mule and because I am hardcore like that, I decided to carry on by foot.

After an ascent of approximately 2,000 meters over a distance of 10.7 miles (8 hours of hiking), we reached camp. We picked up a companion on the way – a small dog belonging to another guide that we passed on the way up. Apparently he had been abused and jumped at the chance to run away because he began following us, whimpering plaintively but refusing to be touched. Celeste and I named him Chufle, which means “electric outlet.” I just think it’s a cute name. Somehow a second, almost identical pooch appeared, and we were really confused until we realized that they were two different dogs (we later found out that they are siblings). We named Chufle’s equally cute, female counterpart Chuleta (“cut of pork”).

The bathrooms at the campsite were beautiful. Unlike Julio’s steaming outdoor chamber pot, they smelled good – like the sun-warmed wood with which they were constructed – and they had working toilets and running water. We were tempted to sleep in the bathroom itself and we spent as much time as possible in it. After changing and washing off a bit, we curled up in our sleeping bags and tried not to move until Julio called us for dinner.

At dinner, Julio informed us that one of the rice bags was infested with maggots, which he realized after preparing it with the canned veggies. He deemed it inedible and made another batch of rice. Since he’d also forgotten the chicken at home, this severely limited our culinary choices for the second night’s meal. (Furthermore, one bag of the bread we’d bought tasted and smelled like the toilet colmado and the other bag – well, Julio said that the rats must have gotten to it, because it just didn’t taste right.) Therefore, he proposed, the best plan would be to complete the 3-4-day hike in only two, meaning that the next day we would finish the ascent to Pico Duarte and then hike ALL the way back down to la Cienaga – a round trip of 28 miles, 2500 meters up and then back down, and 16 hours of hiking in two days. We were in so much musculoskeletal pain that we could only laugh at the prospect of this, but death by falling off a mountain seemed better than death by starvation stuck in the mountains.

That night we slept on the floor of the cabin at the campsite. The next morning, Julio awoke me by hissing in the dark, “morena! What’s the plan? Are we going to finish the whole trip today?”

“We don’t have much of a choice, do we?” I groaned.

Celeste reported that she’d had to use the bathroom in the night, but opted to wait till sunrise due to some suspicious scuffling sounds outside that sounded like neither dog nor mule (there are wild boars in the mountains, but luckily Julio had a machete should one surprise us on the trail). We got up – reluctantly, because it was actually really cold at 2,500 meters; think coniferous trees and steamy breath – and headed up to Pico Duarte, ascending another 500 or so meters to the top. When we arrived, Julio hugged the bronze bust of Duarte (one of the DR’s founding fathers) and we admired the scene around us.

It’s said that on clear days you can see the ocean (and the mountain is located in the very center of the island, in the central-west part of the country), but because of clouds we couldn’t make it out.

Julio smiled at me for the first time and said “you did it well” (remember, I rode the mule for a total of maybe two minutes during the entire ascent). Finally, respect and approval! Then he informed us that our bodies “would never be the same” and that now no one could tell us that we don’t know Pico Duarte. Good thing I have a response now to all those haters who keep taunting me with “you don’t know Pico Duarte, fool.” Happens all the time. We took the obligatory pictures, bade Duarte farewell (at least, Julio did) and then descended back to the campsite, where we ate breakfast and packed up.

The next six hours were devoted to the hike back down to la Cienaga. Downhill is just as hard as uphill, only in a different way. We stumbled our way down the mountainside, trying to enjoy the scenery. It was difficult because 1) we were forced to look down in order to avoid tripping over ubiquitous rocks; 2) if we stopped for any length of time, Julio and the mules would catch up to us and then they would be uncomfortably breathing down our necks (often Celeste and I could hear them coming and would mutter, “it’s the Mules of the Apocalypse! Outrun them!” and tear down the path in order to avoid them; and 3) it really seemed to be about the destination rather than the journey, especially since we were always outrunning the threat of afternoon rain.

When the downhill started to wear on our nerves I began to freestyle. Then we sang The Sound of Music. We were nearing insanity when we finally reached the level portion of the trail. Julio forced us to ride the mules for the last 30 minutes because of the mud, but my hiking boots became soaked anyway after we forded a couple of rivers. Julio took us down the scenic route through town, greeting everyone we passed. Celeste and I felt strangely nauseous.

When we got back to Julio’s and curled up in our sleeping bags, I realized why. My gastrointestinal system had decided to mul-tiny. After destroying Julio’s outhouse multiple times in multiple ways, he and his concerned wife made me chicken broth with noodles and “plenty of garlic” and tea from an herb I’d found along the trail, which Julio said was really good for curing diarrhea. The tea tasted like warm sea water. Julio’s wife heated a tub of tepid water so that we could take “hot” bucket showers in their makeshift, outdoor shower. Despite my body’s unhappiness, showering under the stars was, as usual, magical to me. Celeste began popping back antibiotics, but since my stomach is also hardcore at this point, I stuck it out and was back to normal over the next 24 hours.

We spent the night at Julio’s again and then departed the next morning to return to the capital, weak, our bodies forever changed, but alive. There really are some things that only happen in the DR.

these are a few of my favorite things

1. Shmilsh.
2. Rainy season downpours.

3. A good fan.

4. Spanish. Dominican Spanish.
5. Breakfast in the campo = boiled yucca, pickled onions, fried salami, a tin cup of milk.
6. Guaguas, motos, carros públicos.

7. The Caribbean Sea. The way it looks – is – different every day from my window.
8. Rooftop yoga.

9. Rooftop (6th floor) gym.
10. Colmados.
11. La Zona Colonial and its walls, doors, windows, locks, churches, plazas, and church plazas.

12. Fresh pineapple. Fresh mango. Fresh papaya. Fresh fresh.

13. Caribe Tours.
14. (Shmilsh.)
15. My research. The way it looks – is – different every day.
16. Collecting /shells/coral/rocks/sea-polished glass/driftwood/.

17. Hammocks.
18. Queso de San Juan.
19. My communities.
20. Denbow at an excruciating volume (“yo quiero sapito, yo no quiero maco, maco, maco, yo no quiero maco!”).
21. Chickens.

22. Random fireworks.
23. Cooking curry and stir fry and Spanish tortillas in my kitchen. Getting a good bandera at a comedor. Being fed homemade Haitian-Dominican food in my kitchen.
24. Jugos naturales.
25. Living with a four-year-old.

26. Weekends not in Santo Domingo.
27. My name in Spanish.
28. Flocks of wild parakeets.

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.

all origins ask why

As my Fulbright grant period winds down (just over six weeks left!), I realize it yet again: I can integrate myself all I want into a place, but at the end of the day, I’m also still a U.S. American girl-woman. I’m not Dominican. And actually - I'm happy about that. Then again, things are never that black and white...

You see, I grew up with a very critical view of my home country. I often felt ashamed to admit my nationality when traveling abroad, and preferred to cling to some sort of nebulous global identity, reveling in the fact that my phenotype allowed me to get away with it. It was a combination of disapproval of the majority of my country's actions, nagging class consciousness, and a real embrace of other cultures and ways of life that is grounded in my own diverse heritage. I haven’t rejected that world-citizen identity, per se, but lately I have actually developed national appreciation. I won’t go so far as to call it pride, and maybe a large part of it has to do with Barack Obama, but these days I don’t feel quite so bad about admitting where I’m from.

I like bachata and salsa, but damn, I miss hip-hop and jazz. The beaches here are beautiful, but have you seen the Blue Ridge Mountains or the Eastern Shore? Here there are a lot of Dominicans and Haitians and Haitian-Dominicans, but that's nothing compared to the diversity of the United States, which I sorely miss. Where else but on a U.S. campus can you find a Hindu Student Association diwali holiday event with more non-Hindus than Hindus, or a step show whose audience contains a range of complexions?

And the messed up things that I so despise about my own country are put into perspective the more I learn about the messed up things in this – and every other – country. I'm a Southern girl, and while I love barbecue and country music, I also take issue with the racist ideology that often comes along with U.S. Southern culture. Ironically, though, I think I've faced racism much more blatantly here than I ever have in Virginia - probably because ignorance is universal, and I'm accustomed to Virginian, but not Dominican, manifestations of it. And I'm used to complaining about my own government, but after seeing the level of corruption that exists in this government (I'm talking narco-trafficking ties at the executive level), I no longer think the U.S. is singularly screwed. This makes me excited about re-integrating myself into my homeland and the issues of my own country. Global issues are an important aspect of health inequalities, but at least for the next few years, I think it’s time that I got better acquainted with the local – my local.

At the same time, I have achieved a strong sense of belonging – I speak like a capitaleña, I know my way around this city better than I know most U.S. cities, and I made strong connections with some people and places. I've learned probably as much about myself through experiences in and related to this country over the past three years than throughout all of high school and college in the United States. I guess it’s about spanning boundaries gracefully; knowing how to manage a multifaceted identity, and understanding what can be integrated and what cannot and how. There are interpersonal connections that go far beyond nationality or language barriers, and some things - like music - are universal by nature. At the same time, every place is unique, and I miss the uniqueness of my homeland. The challenge is balancing these seemingly contradictory forces in a single identity.

living the questions

Bye, April. On the (almost) eve of the fifth month of this rapidly disappearing year, I want to share a quote. The past month has been marked by my struggles to come to terms with some aspects of my leaving in two months. I won't go into too much detail here, but suffice it to say that, like most struggles in my life, I find the answers I am seeking among the pages of my slim, hardbound copy of Letters to a Young Poet, by German poet Rainer Maria Rilke. Perhaps my favorite quote from this volume is the one also most applicable to this month's quandaries, and for all those who aren't familiar with Letters to a Young Poet, here it is:

"Have patience with everything that remains unsolved in your heart. Try to love the questions themselves, like locked rooms and like books written in a foreign language. Do not now look for the answers. They cannot now be given to you because you could not live them. It is a question of experiencing everything. At present you need to live the question. Perhaps you will gradually, without even noticing it, find yourself experiencing the answer, some distant day."

Aside from learning to love the questions as I live them, I am also trying to chill out. The data collection portion of my research is winding down, and I have already begun the process of analysis (right now, qualitative coding) - yet another unfamiliar research task that I am teaching myself as I go.

I currently have a friend visiting - someone I haven't seen since we were last together in Peru - and a handful of other friends will be dropping by before my time on the island is up. So I'm also trying to relax a bit more and make a deliberate attempt to enjoy myself, as hard as some of the aforementioned questions are. Even recent weekend trips to the gorgeous beaches of the northern Samana peninsula, Cabarete, and to 27 Charcos, a charming set of 27 waterfalls cascading down a mountain up which you can hike before jumping/sliding your way down, were mediocre for me because of these struggles. But I am determined to return to the U.S. on June 24 relaxed, calm, and peaceful - ready for medical school!

God, part 2

While the Evangelist Jesus talk makes me feel uncomfortable, today I was reminded of the important role of religion in many social movements. I went to a conference/talk related to TB in which a pastor gave a galvanizing sermon about the grassroots movement he wants to start to eradicate TB in the DR. Although I felt frustrated by the social pressure to bow my head in prayer, I was inspired by the pastor's words and gave him my business card, telling him that if there are going to be any health-related grassroots social justice movements in the next few months to count me in. It also gave me some ideas about how to respond to the MDR-TB man's challenge (see my previous entry). It's one thing to write a report, even to get a paper published. Those are nice goals, but I want to change something. And I now have some ideas about how to do so.

Later, I began to reflect on the legacy of Gustavo Gutiérrez and other revolutionaries whose motivation to act springs from a religious base. Much of the community organizing for social justice in the U.S. began (and continues to begin) in religious contexts - from Martin Luther King's pulpit leadership in the Civil Rights Movement to Barack Obama's career as an organizer beginning in the church basements of southside Chicago. If you aren't familiar with Gutiérrez's framework of liberation theology, check this out:

"But the poor person does not exist as an inescapable fact of destiny. His or her existence is not politically neutral, and it is not ethically innocent. The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited proletariat, robbed of the fruit of their labor and despoiled of their humanity. Hence the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different social order."

— Gustavo Gutiérrez

Sounds like revolution to me! So I am hope that I am not misunderstood in my lamentation about the hyper-Christianity of some Dominicans I've encountered. I don't wish to imply that there is something inherently wrong with being religious; I just balk at proselytizing and attempts at conversion of others. I think that when religions of the world can learn to respect each others' inherent similarities and the moral mandate of justice-seeking that nearly all possess, faith will be a powerful tool for social change. But only if such a movement is broad enough to include all faiths as well as secular civil society. True activism finds a way to promote the inclusion of all interested parties, since the point of activism, after all, is to rearrange the social orders that result in marginalization, exclusion, and other injustices.

timeline

So I’ve bought my return ticket. In just over two months (June 24, to be exact), I’ll be heading home. And I’m about ready. I’m coming to terms with leaving the things that I love here, and as for everything else…well, I’m not so torn up about leaving the things I don’t love.

For example, Dominican elections are in less than a month, which means that the entire country is becoming increasingly filled with apparent flashmobs of people cheering for one politician or another, backed up by huge posters that all have the same catchphrases below their candidates’ beaming faces (“change…now!” – “friendly and capable” – “honest and trustworthy” – “the people’s Senator!”). Of course there is ridiculously loud merengue, some of it made-up political songs and some of it incongruous Omega tunes that are meant more for hip-to-hip grinding in a Presidente-filled colmado than for a political rally. A lot of people tell me that these mobs of “supporters” are just random people that candidates pay to stand around waving flags and acting like they are very excited. Given the general attitude of most Dominicans about politics, this isn’t hard to believe. The vast majority of people are skeptical of politicians – not difficult to understand when higher-ups in the government are known for corruption, from money laundering to narco-trafficking, and in decades of elections promising monumental change the government somehow still cannot manage to guarantee electricity and access to clean water for everyone. Oh, and in case that wasn’t clear, Dominican elections count as something I don’t love because I can’t stand social inequality or excruciating noise.

Here is another anecdote that I think epitomizes why life in this country has lost some of its charm: the other day a washing machine crashed into the guagua (public transportation in the form of a beat-up bus that violates all environmental and safety standards for probably every other country in the world) I was on. No, seriously - I was sitting up front and I saw the whole thing happen. We were driving through the barrios on my way to the clinic when, as if in slow motion, a washing machine came hurtling down the road toward us. It skidded into the left side of the guagua, and everyone who hadn't seen what it was swore we'd hit one of the ubiquitous motorcyclists. The driver got out and, cursing, dislodged the washing machine from the bus fender and deposited it on the side of the road. It's difficult to explain why my next thought was, only in the Dominican Republic. I hope it's not hard to understand why I'm a bit homesick for a country where washing machines do not routinely crash into vehicles in the middle of the road.

One of the most important questions about leaving, however, is what I’ll be leaving behind, work-wise. One of the TB patients today (the man with MDR-TB about whom I wrote a few entries ago) asked me what the outcome of my research would be. “What are you actually going to do if we tell you that we aren’t treated well? That we have problems here?” I felt ridiculous saying, “well, the hope is that what I learn will help to inform future TB programs, but I can’t promise concrete changes in the way things are run at this clinic.”

What am I actually going to do? One of the good things about my timeline is that I feel only a pressure to get all the data collected, but not necessarily to analyze it. That next research step is something I can always do from the U.S. While this might be completely delusional given the fact that I am going to be a first-year medical student as of this August, it makes me feel better about June’s approach. It also gives me the freedom to do a few other things I want to make sure I get done before I leave – things that can’t be done from home. I have at least a few friends coming to visit me before my time here is up, so I plan to squeeze in the last bit of traveling I want to accomplish when they arrive. And of course there is spending time with the people I won’t be seeing regularly once I move to Tennessee.

Research-wise, I have much to accomplish and the work will not end with the end of my grant. In case you weren’t thoroughly convinced of the urgency of it by the last few entries, here’s a recent article in one of the main Dominican newspapers. If you don’t read Spanish, allow me to summarize: According to the Pan-American Health Organization, the DR is the country with the third-highest rate of TB incidence in the Americas. Factors responsible for the high incidence of TB include concurrent disease incidence such as HIV/AIDS, diabetes, and cancers, malnutrition and hunger, socio-economic inequality, and poor living conditions – all of which are prevalent in the DR.

So thanks for the challenge, MDR-TB guy. Let’s hope something useful comes out of all this.