by Margaret Means
Margaret is a Timmy long-term volunteer, serving as a medical programs assistant in Monte Cristi, in the Dominican Republic. She started working with Timmy in August 2013, after graduating with a degree in Biomedical Engineering from Vanderbilt University. She will continue to support Timmy’s international programming through February 2014, after which she hopes to attend medical school. This blog highlights the critical nutrition issues affecting public health in the bateys – the rural communities that Timmy supports along the Haitian border.
When I first came to Monte Cristi, I was pleasantly surprised by the relatively low prices of fresh fruits and vegetables. I thought, “Oh good! I can stay on budget AND eat righ!” So it came as somewhat of a surprise to me that people here don’t eat many vegetables. It turns out that even though they are cheaper than they are in the US, they are still relatively expensive compared to other foods, and people earn much less here in general, than in the states, for doing similar jobs. So, with 25 pesos, you could buy 2.5 pounds of rice or one apple. One dollar is about the equivalent of 42 pesos. Bananas, plantains, potatoes, and yucca (another starchy root vegetable) are all low cost as well, and you see at least one of these foods at almost every meal (usually fried).
But cost is just one of the reasons that few vegetables make it into the average diet. I was talking with Dr. Garcia, Banelino’s physician who serves patients in the bateys, and he said that a lot of the dietary habits have to do with local culture and the traditional ways of preparing and eating food. No specific vegetables, apart from potatoes, are in traditional Dominican dishes. There are some diced onion, bell pepper, carrots, and corn in some of the stewed bean and rice dishes, but the vegetables themselves are not usually eaten as a separate side dish. The only type of lettuce I have seen here is iceberg, which contains few vitamins and minerals compared to darker shades of lettuce. A salad will sometimes accompany a meal, but when it does, it is usually very small and covered with oil, vinegar, and salt. Many traditional meals here are also served with some type of juice or soft drinks – usually loaded with lots of added sugar.
The consequences of a diet high in starch, fat, and sugar, and low in nutrients and vitamins, are seen when we visit patients in the bateys. Poverty is common in these communities, which means they generally buy the cheapest foods available. Lunch is usually a heaping plate of white rice with beans and maybe some fried plantains and avocado. As a result, Timmy has many chronic patients with high blood pressure and diabetes. These patients don’t necessarily manifest as obese or even overweight, but their diet – high in salt and simple carbohydrates – can still cause these problems.
During our last medical trip, Timmy’s nurses commented on the frequency of ketones found in the urine samples – which indicates malnutrition. They said that most of the people didn’t appear to be underweight, but the ketones were a result of not consuming enough vitamins or nutrients, despite consuming plenty of calories. These widespread health issues are further compounded by a lack of education and knowledge of what a healthy diet actually looks like. When culture and economics dictate that rice, beans, and fried roots equal a meal, we’re faced with a deeply seeded issue that will continue to cause high blood pressure, diabetes, and malnutrition.
So what are Timmy Global Health and Banelino going to do to help resolve these issues? As I mentioned, these problems are deeply rooted in culture and custom, so we will not get people to change their diet overnight. But, working with Montana State College of Nursing November 8-17th, we’re launching our first public health education trip to Monte Cristi. The first step to amending this region’s nutrition problem is to understand exactly what the problem is – which in this case, means knowing exactly what the people are eating and WHY. Does it have to do with accessibility? Cost? Tradition? Lack of knowledge? All of the above? This is what we are hoping to begin to understand with the help of this public health team. During this trip, teams will conduct house visits to gather information about the dietary habits of patients and collect additional data on any health problems they may have. With a greater understanding of the community’s health status and nutrition practices, we can hopefully begin to craft a solution that will impact these communities in a positive way.
As a (hopefully) future medical school student, I have a fascination with the effects of nutrition on overall health. Part of my long-term volunteer project for Timmy involves compiling a diagnostic nutritional survey that we will use during the public health home visits to assess the diets of our patients and the reasons why they eat what they eat. I am hopeful and excited that we can begin to make a difference, no matter how small it may be. You have to start somewhere!