Missing Health Care

New Orleans: Yesterday returning to New Orleans – and home – seemed full of surprises.  Spring was everywhere.  Pink and white azeleas were blooming around the house.  New growth had the bright green unique to the season.

 Another pleasant surprise was a dear note from a companera, Terese Bouey, who sent along some of her favorite – and long promised – pictures from a trip we both shared as part of a delegation assembled by the Organizers Forum to New Delhi and Kolkata, India.  (Check out www.organizersforum.org — where one can find other pictures from the trip and a full report of the activity!)  Looking through the pictures of our group meeting the CITU – the Central India Trade Union – in Kolkata brought back memories, as did one of us receiving flowers and ceremonial welcoming marks on our foreheads at the Great Eastern hotel owned by the city government there.  What a trip and an education!

 All of which made my eyes immediately hit the bottom of the front page of the New York Times this morning as I awoke to an article entitled “Deserted by Doctors, India’s Poor Turn to Quacks.”

 The article turned on two different, but related problems, one of which a World Bank report argued was widespread throughout the underdeveloped world, and that was huge and devastating absenteeism and abandonment of the health infrastructure in these countries by health care professionals – doctors and nurses – themselves.  The study found that in India, Bangladesh, Indonesia, and Uganda medical personnel were off premises 35 to 40% of the time.  Peru was only slightly better with a 25% absenteeism rate.  The article indicated that India was spending about $2.00 per person (compared to $2000 per person in the U.S.) and in another twist of fate had increased the expenditures recently for raises – among other things – for the docs and nurses who are not on the job. 

 A cruel and expensive irony, it would seem.

 The second problem was bred partially by the first.  When Indians cannot find the public health professional, they go to whoever and whatever is available, and that is an untrained amateur trying to make a living.  Interviewing some of these folks was a tragic picture of put upon working stiffs, who felt that they were meeting the demands of the market for shots and glucose drips, because that’s what the patients wanted:  medicine on demand in other words.  The pros partially were no-shows because they didn’t have any meds to work with much of the time and were suffering from bad morale because their patients wanted remedies more symbolic than real, which they could not provide.

 A catch-22 from hell that leaves one caught between laughing and crying, made all the more terrible because it ends up about nothing but another way of dying.

 Every spring still seems a pleasant surprise, though nearly identical to the previous year, while India – and too many other “hard done by” countries and peoples, seem still staggering in the immense magnitude of the unimaginable chaos and catastrophe of a constant and continual shock surpassing any reasonable expectation.


ACORN Dominican Council: Elections

Santo Domingo/New Orleans: Flying back from Santo Domingo to Miami and now onwards towards New Orleans and home allows one to reflect more on life on the other side of the looking glass.

 Yesterday for example we began our day with a visit to the main hospital in Santo Domingo accompanied by the head of the nurses union (SINATRAE) and the CGT – the Conferacion General de Trabajadores.  It was a strange strike, and ACORN’s Dominican leaders had trouble believing that in fact it was really and truly a strike at all.  They expected signs, police, and noise.  There was none of that, and in fact we were all almost immediately ushered in by the union reps to see the Director General of the Hospital, who was excessively gracious and accommodating.  When Maria Polenco, ACORN’s National Vice-President, asked him to explain his relationship to the union since he seemed so calm in the middle of a strike, he answered essentially that he saw his role almost as a mediator, rather than a manager, taking messages to the General Secretary of the Health Department.  It also seemed clear that with elections seven weeks away, that nothing much was going to come of any of this until the governmental direction was settled.  In fact had there not been an article in the paper, there is no doubt that ACORN’s hard-bitten, demonstration-toughened leaders would have seen this as a charade.  It was at the least an education in a different type of tactic.

 Today before I sprinted for the airport we met with an interesting – and large – NGO in the DR, Participacion Ciudadana.  Among their projects in the ten years of their existence were trying to cleanup elections and increase their transparency.  For the first time, as I believe I have already mentioned, Dominicans with dual citizenship will be able to vote from abroad.  They needed our help, because the overlap of polling places for Dominicans in the US was a close match for our offices in the US.  Providing election observers on our own turf seemed like a good, solid first project for ACORN’s Dominican Council to sink their teeth in and advance their network throughout the northeast.  The offices were a litany that one would expect:  Boston, one in Providence, several in Jersey – Paterson, Union City, & Camden – 104 in New York City ranging throughout our groups in the Bronx and in Washington Heights.  The leaders were excited – this was something that could really be done!  Not a big, huge thing, but something solid that would build some bridges back home.

 And, here at home and away is a confusion and a contradiction – though not widespread really.  A Dominican – who is a citizen of the United States now and a recent immigrant – could vote for two Presidents this year – once in on May 16th right in the Bronx – and then again in November – also in the Bronx from another location.  One President would end up in an American constructed palace built for Trujillo, and the other would end up in the American constructed White House in Washington.  We spoke to Hatuey De Camps, President of the Partido Revolucionario Dominicana (PRD), earlier in the day for a brief period before he went into a press conference, and we asked him about this irony.  He shrugged and laughed with immense good humor, and basically said answering our question about why it was so hard for dual citizenship holders to be able to register to vote this spring, that the United States was not encouraging this kind of activity these days, and thought people should make up their mind and decide. 

He offered that report without an opinion of his own. 

On the other hand he also individually polled every member of our delegation about whether they were planning to vote for Bush or Kerry – and reported the vote to his aides as they brought messages into him, and tried unsuccessfully to hurry him along. 

Perhaps we had his opinion after all.