2011 Competition Winner (c)

Esperanza: Health and Human Rights on a Dominican Batey

by David Simmons

(Anthropology, University of South Carolina)


The ground is crusty, a bricolage of hard and crumbly pieces, strewn with food wrappers, broken bottles, paper, and in some places, human feces. Many of the houses are made of pounded out coffee tins, known locally as hoja de lata. Some are made of various wood debris, layers of odd pieces nailed together over many years. A few lucky residents have cement block homes. The bright paint—eggshell blue, cotton candy pink, hunter green—adorning some stands in stark contrast to the rusty, decaying brown of others. Because living spaces are so small and so unbearably hot, most people spend the better part of the day and night outside. Many of these homes have been divided and sub-divided so many times they resemble labyrinths upon entering them. Circumscribing such communities—primarily Haitian agricultural communities referred to as bateyes—is a sea of sugar or rice or coffee extending as far as the eye can see. The verdant beauty of these fields masks the great human suffering that maintains them.

This community is called Batey Esperanza. More than 20 building structures hug the well-traveled Dajabon Road—the road that brings thousands of Haitians every year, sometimes illegally, into the Dominican Republic. The rest of the community extends back toward the Sanjan River that, despite its pollution, remains a favorite place to cool off in the wretched heat of the day. The banks of the river serve the dual purpose of garbage dump and open air latrine—the sharp, acrid smell of urine suffuses the air. One must always walk with one’s eyes on the ground here. There are latrines; however, they are not sufficient to meet the needs of the entire community. The northern border of the batey is the vast expanse of rice fields where many men in the community work, bent over for hours a day in knee-deep mosquito-filled water. Due south of this area is a large “play”, doubling as both a soccer and baseball field. Its rock-strewn surface quickly eats through cleats and tennis shoes and so it’s always surprising to see small children, shoeless, participating in soccer games that last for hours. The cluster of homes sprinkled around the play are primarily owned or rented by ethnic Dominicans. This is considered the nice side of town. Homes are not densely packed together as they are in other parts—that is, Haitian parts—of the community. Rather than the neighbors’ ramshackle homes, the view from here is the emerald ocean of rice that ends with a section of large palms at the autopista, the Dajabon Road. Beyond this sits the cloud-veiled hills that separate the Cibao Valley from the sprawling sugar plantations and all-inclusive tourist destinations of the northern coast.

Latent hostilities simmer beneath the social and biological environments of this small community, always threatening to boil forth. When the Guardia Nacional raided the community recently and carted off three quarters of the Haitian population, Haitian residents accused resident Dominicans of not only being complicit, but of robbing Haitian homes of valuables in their absence. Anti-Haitianism, long a feature of Dominican society, taints relations here, no matter that Haitians and Dominicans are equally poor. Years after countless United Nations and other human rights organizations’ visits to investigate anti-Haitianism—and the exploitation and human rights abuses of Haitian workers—the plight of this population remains relatively unchanged. Talk of derechos (rights) is something outsiders do, usually for their own benefit, local people will tell you.

Depending on the season and the labor needs of local plantation owners, the size of this community expands and contracts to anywhere from 900 to 1,500 individuals. There are fourteen colmados (in-home grocery stores) and two churches—one Protestant (Evangelical), the other Catholic. Four 20-room barracks, a vestige of the time when the batey was owned and managed by the State Sugar Council (Consejo Estatal de Azucar, or CEA), rest within close proximity of one another in the southern half of the community. Slowly, very slowly, the barracks are being torn down, cell by cell, as new cinderblock homes take their place. It is, as one local leader is fond of saying, an effort to “rewrite” the history of the community—a history that stretches back to when this pueblito (small town) was called Batey Rafael, in honor of the dictator Rafeal Leonidas Trujillo, the man responsible for the largest massacre of Haitian people back in the 1930s. Haitian resilience since the advent of this mass killing (locally referred to as el corte, or the cutting down) gives us some insight into the cultural cache from which they draw to meet the many exigencies of living and working in the Dominican Republic.

This book tells the story of how resiliency has many faces, that it is drawn from many places. Inasmuch as it is the result of historical circumstances, it is also forged in new contemporary encounters and relationships (and not without their own costs). The dynamics of such resiliency require that we rethink how we understand seemingly out-of-the-way communities such as Batey Esperanza. Members of an American church come every summer to help construct new homes, for example. Batey Esperanza, unlike many bateys, has a long history of involvement with North Americans. It was the Americans who built the latrines and the aqueduct with semi-potable water from the mountains. It was the Americans who built the two small parks with gazebos and Nim trees that provide a cooling respite from the sun and tropical heat. It is the Americans who started a fund to help pay school fees for local children. It is the Americans who, at various times during the year, pass through bringing money, clothes, and whatever else they may have collected from their churches, families, and friends. In fact, most folks will tell you that it is the Americans who will do what the Dominican government does not. “The Dominican government has never made any effort to help Haitians, not a single Haitian. We’re only here to be stepped on,” laments one longtime resident.

And yet, there is a government presence on the batey. Aspiring local politicians will make it a point to pass through during campaigning. One, a pediatrician, offered free consultations for children in the community. After losing the election, she hasn’t been seen since. A municipal truck comes to pick up garbage every eight days. Only garbage in garbage cans, or cubos, is collected. If refuse is not in a cubo—and the majority of households do not have cubos—it lies in the community, attracting various roaches, rats and other vermin. The municipality, in a special deal, also provides free electricity to many homes. Thus, in the midst of what the average observer sees as overwhelming poverty, it is not uncommon to find refrigerators, TVs, stereos and the occasional VCR in this community. The governmental presence is most powerfully felt during redadas, or raids, on the community by la Guardia Nacional, usually carried out under the pretext of looking for undocumented residents. The subtext is usually commercial in nature: plantation owners, in need of able-bodied men, will commission local authorities to round up workers. When confronted by the authorities, the choices are quite simple, as pointed out by one community member:

Well, you have two options: If you don’t want to go to Haiti, you have to go and cut cane; if you don’t want to go to cut cane, you have to go to Haiti. But me, I don’t want to go to Haiti. Yes, I am Haitian, but my country is bad, it is hard, it is a country where there’s nothing to do.

There is another option, too. You can pay a bribe and, thus, be left alone. But the paltry 70 pesos most agricultural workers in this community make on a daily basis goes toward food, school uniforms, or badly-needed medicines. There isn’t much left at the end of the day to pay a bribe. And so when the police come, local people go to Haiti or to someone’s cane, coffee, or rice field. On rare occasions, some go to their graves. As one young man says, “They can come and get me, take me into the bush and kill me. And no one will care.”

There are less obvious ways people are being carried to their graves. Take the case of Andres Giles, age 52. He left Batey Esperanza in 1988 to go back to Haiti. He returned last year, chronically ill, saying the doctors “over there” couldn’t tell him what was wrong with him. He had a bad cough, night sweats, and was losing weight. His once-kinky black hair had become straighter and auburn red highlights had begun to assert themselves. Eventually he found his way to the public clinic in Esperanza where he had blood work done. For both HIV and TB, the initial tests turned out “inconclusive.” After a second battery of tests—that also came out inconclusive—Andres began taking a series of pills daily, under the observation of the clinic medical staff. He had no idea why he was taking the pills because his doctors did not tell him why. Because Andres is still too weak to work and, hence, pay for transportation, he walks the 7 kilometers to the clinic. Because he cannot work, he lives off of the kindness of the community which provides him a room as well as meagre daily meals.

Still worse off than Andres is his girlfriend, Celise. She, like Andres, is a Haitian national. But unlike Andres, she does not have a valid visa. This means she is not free to travel outside of the batey, less she be stopped by local authorities and imprisoned or deported or worse. Like Andres, too, she has TB. Or at least the one time she risked going into town to the clinic, the doctors prescribed the same pills Andres was taking. But because her visa has expired, she cannot risk the daily trek to take her medication. So, Andres walks into town to take his medicine and collect hers, which he brings back to the batey for her to take in safe surroundings. She admits it’s hard to take such powerful medications on an almost always empty stomach. They make her nauseous.

In sharing the stories of Batey Esperanza, I uncover local forms of resiliency in what the outside observer sees as overwhelming exploitation, shattered hopes, human rights abuses, and poor health outcomes. A large part of the problem in ameliorating the suffering of this population, I argue, is outsiders’ inability to move beyond their own ethnocentrism; their own inability to see the creative and revolutionary potential that is the bedrock of local culture. Externally-imposed “rights”-based approaches make little sense in this context—they are high on rhetoric and low on practicality—“They can get you killed,” as one resident puts it. Likewise, outsiders’ talk about rights often disguises a sense of proprietariness and self-serving involvement in “developing” the community, a kind of paternalism the community is quick to recognize.

But if the example of Batey Esperanza requires that we rethink rights-based rhetoric, it also requires that we rethink the very meaning of health and wellbeing as it intersects with issues of social justice. How is health defined and negotiated in a politically-charged and historically-divided community? Why and how do people who suffer serial bouts of infectious disease (as well as chronic disease) still self define as being in good health? Residents’ stories reveal a complex and fractured understanding of health that is rooted not only in somatic states, but social, political, and economic states as well. This more expansive and holistic sense of health helps explain why narrowly-targeted health interventions often have limited success in settings such as Batey Esperanza.

Overview of the Chapters

Introduction. “I Can Live With Racism And Discrimination, But I Cannot Live With Hunger”
Hunger—the need to feed family and self—pushes many poor Haitians to migrate to the Dominican Republic. In the introduction I cover the reasons for the migration of Haitians to the Dominican Republic, their motivations and expectations, the historical development of the bateyes and their material conditions. I also introduce the stories of a few batey residents (for example, an undocumented woman suffering from stage-three breast cancer who, with great difficulty, found a way to get around police check points to see doctors in the city) highlighting the obstacles they face in their quest for health, wellbeing, and social justice.

Chapter One. “Salud Es Vida (Health Is Life)”: The Story Of The Dominican-Haitian Health Promoter
Health promoters are a common feature of community health, particularly in low-income countries in resource-poor settings. This chapter focuses on a Haitian community health promoter (named Don Pere) and his efforts to foster wellbeing in an environment where overwhelming health and social challenges exist (HIV/AIDS, malaria, dengue, diarrheal diseases, anti-Hatianism, etc). Don Pere’s story is unusual in that it reveals the challenges of Haitians born in the Dominican Republic who often feel competing loyalties between both the Haitian and Dominican communities. His story also illustrates how health care access is always a politically negotiated effort as it is usually mediated through a Dominican patron.

Chapter Two. “It’s Not Only The Haitians Who Are Suffering, Poor Dominicans Are, Too”: The Story Of The Dominican Health Promoter
The challenges facing a mixed community—both Haitian and Dominican—are illustrated in Batey Esperanza in any number of ways, but certainly in the relationship between national status (citizenship) and health. This chapter offers a counterpoint to Chapter One, exploring Dominican conceptions of community health practice from the perspective of a Dominican health promoter (named Doña Eduvigis). Doña Eduvigis’s story shows how many Dominicans in the community tie health—and more specifically access to health care—to ideas of belonging to the soil (tierra).

Chapter Three. “I Don’t Know What’s Wrong With Me”: Anti-Haitianism, Health Care, And Structural Violence As Social Practice
Geographic segregation, access to transportation, occupational and environmental health challenges, and negative treatment by doctors and other health professionals—all expressions of structural violence—emerge as salient impediments to health and wellbeing for poor Haitians in the Dominican Republic. This chapter illustrates how structural violence, especially through the mechanism of anti-Haitianism, works to both create environments that undermine the wellbeing of Haitian agricultural workers and, when seeking treatment, can limit opportunities for access to care.

Chapter Four. Pragmatic Solidarity? The Politics Of Coalition Building With Outsiders
One of the primary strategies residents of Batey Esperanza have used in recent years to better their lives is strategic relationships with outsiders. These outsiders range from local NGOs in an adjoining town to university students in nearby Santiago to students from international universities. This chapter examines the micro-politics of these relationships, analyzing their often hidden costs as well as benefits.

Chapter Five. Famn Vanyant (Valiant Women): Health Challenges For Haitian Women
Haitian immigrant women suffer a disproportionate number of health problems (as compared to their male counterparts) in large part because of the demands of child-bearing, limited proficiency in Spanish, and gender ideologies that work to undermine women’s agency. This chapter highlights Haitian women’s efforts at bettering their condition through the development of a community-based women’s group that focuses on economic development and leadership capacity building.

Chapter Six. “Your Rights Aren’t My Rights”: Defining Rights From The Bottom Up
This chapter explores the discrepancy in international human rights rhetoric and the ways that human rights are understood and defined from the bottom up—that is local theorizations of rights. Community conceptions of rights are premised on social relationships—with family, patrons, and neighbors—as well as people’s relationship with the land rather than ideal of civil, social, and economic rights often espoused by the international community.

Chapter Seven. Salud Es Vida (Health Is Life): A Community Heals Itself
Despite the perception that it is outsiders who are the primary providers of health care and human rights protections, Batey Esperanza’s residents are agents of their own change. The historical and present-day efforts of the community in this regard are often obscured because outsider would-be agents of change do not have long-term residency in the community and their relationship to the community can have proprietary tones to it. Likewise, many of these outside agents are not fully proficient in Spanish or Kreyol and so miss the often subtle ways that the community acts on its own behalf.