Written by HHI’s current research intern, Heidi Berthoud.
Water is accessed in many ways in the Dominican Republic, usually through a combination of waiting for the local city water to be turned on (most likely not potable), buying water from large trucks that come house to house (not potable), buying large 5-gallon bottles (supposed to be potable), or gathering water from a natural source like a spring, well, or river. I came to the Dominican Republic to work with Health Horizons International (HHI) to investigate local attitudes and practices surrounding water use and access in several small communities around Montellano. The plan was to use the information I gathered to both aid HHI in their public health planning around water in the local communities and to form the basis of my MPH thesis.
About three days after I arrived rumors of cholera began spreading through Pancho Mateo and the other small communities along the river near Montellano. A baby died of suspected cholera in Pancho Mateo and more suspected cases were arriving in both the small, local hospital and the larger community hospital in Puerto Plata. The local Ministry of Public Health took action and decided to host a community forum comprised of a panel of local water and public health officials as well as members of the military. Through the networking of the HHI team here, we were introduced to the director of Public Health for the Puerto Plata region (Dr. de Pena) who then came to give a charla (group information session) to the HHI community health workers and invited us all to attend the larger community forum. The first announcement from the Ministry of Public Health was that they were planning to “militarize” the river and block the communities from continuing to bathe, drink, defecate, and throw garbage in the river. They explained the etiology of cholera and how it was a feces borne illness that proliferated in conditions where people came in ready contact with contaminated human waste. They urged everyone to wash their hands after going to the bathroom, before preparing food, and after changing a baby’s diapers, and they urged everyone to buy chlorine and chlorinate all drinking water in order to avoid the spread of the disease.
Many leaders of the local community groups and neighborhood associations arrived at the forum well prepared with statistics and data regarding the chronic lack of access to potable water and proper human waste disposal. They voiced their frustration that the concerns they had been raising for the past few years to the government about the lack of water access and a sanitary means of disposing waste had now created living conditions where cholera could thrive. Times are tough here and many people in these communities are unemployed or underemployed. The community leaders were beyond frustrated that the ministry and the government was insisting their community institute a plan that requires them to have access to something (clean, regular water and latrines) that many don’t have and can’t afford to have. I was very impressed at how organized and knowledgeable the community leaders were and how prepared they were to fight for improved conditions in their communities. After a lengthy debate that lasted well after dark, the ministry of public health announced they would be sending trucks filled with clean water which would be distributed for free in order to provide the community with a consistent alternative to the river.
With this as a backdrop, I began my research here and decided to focus primarily on two communities; the small but densely populated community of Pancho Mateo where the suspected cholera outbreak was and where both Haitians and Dominicans live side-by-side, and the rural and remote community of Arroyo de Leche which is comprised primarily of Dominican agricultural workers. My first order of business was to check out the river in Pancho Mateo and the various water access points in both Pancho Mateo and Arroyo de Leche. I immediately saw that despite the seemingly absolute declaration that the river would be “militarized” I saw no military presence and many people continuing to use the river for water access. I also discovered that no free water was being delivered as planned and even now, nearly four weeks later, only one free water truck per week arrives and this is apparently via an evangelical church in Arizona. I spoke with several water truck drivers and they all assured me that they charge for the water in their tank. Many people in Pancho Mateo continue to complain of diarrhea related illness and many expressed the thought that whether it’s cholera or not, being sick is just a normal part of life here.
Last week Tracy (Public Health director at HHI) and I had a productive meeting with the Ministry of Public Health. When I expressed interest in seeing the local water filtration plant they said that we could come with them on a visit there this week. One of the scientists working on water analysis (Dr. Marmolejos) was surprised and upset to learn that no free water had been arriving in Pancho Mateo as promised. He was equally surprised and upset when I showed him pictures of the rudimentary water access points in Pancho Mateo. I hope we can address some of these concerns when we meet with the water filtration officials.
What I’ve found, to my surprise, is that the remote community of Arroyo de Leche has fairly regular water access. They tap into the local acueducto and for a fee, they pay to have piping installed in or near their homes. There are also many natural springs that flow regularly and provide seemingly clean drinking water. So far, no one in Arroyo de Leche has expressed that they are without water or that they suffer regularly from diarrheal illnesses.
In the meantime I plan to continue interviewing households in both communities to see what the common water themes are. I have two fantastic local research partners, one of whom is able to help translate Haitian Kreyole during the interviews with the Haitian community and can also explain the intricacies of Dominican slang. Already it’s clear that the Haitian section of Pancho Mateo has the least consistent access to water and latrines, which also adds to their sense of feeling stigmatized since cholera arrived on the island in Haiti first. As I’m quickly learning, water access is a complex political issue. One woman I spoke to in Pancho Mateo insisted that the water pipe being fixed in front of her home was the work of the PLD, which is the major political party here. In an ironic twist, it may just be the cholera outbreak on the eve of a presidential election here in the DR that helps bring water to Pancho Mateo.
Information sheets about cholera in both Kreyole and Spanish
Dr. de Pena presenting at the community forum
One of many community leaders explaining (yet again) why they need access to clean water and latrines
This woman said she was a chemistry teacher and had performed her own test of the local water. She challenged the local water district director on his assertion that the water that did occasionally arrive from the city was free of bacteria
A community leader in Pancho Mateo (and HHI Community Health Worker) being interviewed by the local news the day after the cholera community forum.
Water collected from the river in Pancho Mateo
Some members of the community continue to use the river in Pancho Mateo
Willy (research partner and HHI Community Health Worker) investigating a water access point in Pancho Mateo. Residents said they aren’t really sure when the water will arrive, but since the cholera outbreak some parts of Pancho Mateo are now receiving city water every three days.
Elena in her house in the Haitian section of Pancho Mateo with the buckets she uses to collect rainwater from her roof. She said she also shares this water with her neighbors.
One of several water access points in the Haitian section of Pancho Mateo that was being used for corn preparation. I was told jokingly that the water arrives here every year on January 1st.
Investigating one of many cisterns, found primarily in the Dominican section of Pancho Mateo. When the city does send water, people can fill their cisterns but otherwise they have to pay to fill them.
Consistent running water access in Arroyo de Leche
Washing dishes in Arroyo de Leche
Corina (HHI Community Health Worker) and Nuorcia standing across the stream from one of several natural springs in Arroyo de Leche
Water being delivered, for a fee, to a nice neighborhood in Montellano
Bottle of “purified” drinking water in the HHI staff house which we purchase for about 1 USD each. There isn’t any regulation on the water purification companies that sell these bottles so everyone relies on local word of mouth regarding which is the best. A public health official just told us that “Agua Honey” is the best.
Dr. Marmolejos preparing to show us how they test the mineral balance of the water.