DOMINICAN REPUBLIC (cont.): The clinics I visited this afternoon were embarrassingly short of any medications or supplies. When I inquired about the lack of pharmaceuticals and basic supplies, the attendant at the Barranca clinic wrinkled his forehead and sort of looked at me in a puzzled way.
“We are pleased we have these supplies. We just received them yesterday. Before these supplies, we had not received any others since last April” was his reply. He then proudly showed me a small wooden box with an ill-fitting wooden lid. Inside the box was inoculation medicine for children. The medicine, which must be refrigerated, was packed in ice cubes that were rapidly melting in the hot climate. None of the clinics I visited had any kind of refrigeration.
This evening I was invited to join the executive committee of the Rotary Club for dinner. There I had the opportunity to tell them about the work of Project C.U.R.E. around the world. The genuine kindness of the people and the dedication to making their city of one hundred thousand people a better place to live really encouraged me. They were almost overwhelmed that Project C.U.R.E. would come to their city with the possibility of helping them. No other organization has ever come to help them.
At dinner Dr. Miguel de Pena told me that their main hospital has been without an X-ray machine for months. Some people in Miami said they would try to help them get another X-ray machine, but Dr. Miguel never heard from them again. The committee told me that Project C.U.R.E. coming to La Vega is an answer to their prayers. We talked about the fact that I had not even counted on getting La Vega into my schedule until sometime in 1999. But rearranging the schedule for the Vietnam trip left just these few days available, and I felt strongly that I should contact Cesar Abreu regarding my trip to the Dominican Republic. It almost seemed, they said, like it was divine providence.
They have been totally without access to even one X-ray unit for almost six months. The old, broken General Electric unit had been dismantled and was lying on a piece of concrete slab between two buildings. I asked what they do for X-rays for diagnosis. They simply replied, “We do without.”
I got into quite a discussion with all of the medical people in the room regarding the philosophy that the government could promise and deliver adequate health care to the total population without charging each patient some amount for the service. When I brought up the subject, I knew immediately that I had hit a raw nerve.
“Everywhere I go today around the world,” I observed, “those with health-care responsibilities for the general public are coming to the conclusion that their government cannot continue to expect to cover all costs of health care. What makes you think the Dominican Republic can cover everything for everybody? Obviously you are not doing it now, are you?”
Their answer to me was typical. “The politicians here depend on the vote of the people to gain office. Any candidate running for an elected office who would even mention the possibility of not giving free health care to the constituents would be a fool. He would never get elected.”
We had to move on with the assessment study, but my final thought on the subject was to challenge them that no one is receiving health care for free now in the Dominican Republic, and in my opinion, it will only get worse in quality, not better, until they figure out a way for the individual patients receiving the service to directly contribute something toward the services they receive.
The fact that the main hospital is trying to function without an X-ray machine, without monitors of any kind, with only one small autoclave, and with no lab analysis equipment certainly underscores the conclusion that the hospital simply needs everything.
Next Week: Designing a Plan
© Dr. James W. Jackson
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