Although they share an island and an interlinked history, Haiti and the Dominican Republic are very different places. On the Dominican side of the island Christopher Columbus landed in Santo Domingo, setting in motion the colonization of the Americas. The island if Hispaniola is home to many “firsts” in all of the Americas. First school, first hospital, first church, first settlement, first slave-based economy, and first slave revolution which resulted in the independence of Haiti.

Haiti is the poorest country in the Western Hemisphere; more than 50% of the people live on less than $1.50 per day, and 76% are living on under $2.00 per day. Even worse, 85% of the rice (national food) consumed is American imported rice — meaning they pay the same prices for food we do in the United States. Over 75% of the population in Haiti is rural, and statistics like this can help to explain why. The opportunity to grow food and raise animals gives more control of your outcome in terms of hunger and malnourishment than living in an urban environment on such low wages. Of course, living on an average of $1.50 per day means that some days you make $5 and can eat, but many days you make nothing. Across the border in the Dominican Republic, the average daily wage is around $10, not even in the top 10 poorest in the Western Hemisphere — but still more than one third of the population lives on under $1.50 per day.

In Haiti we served in a rural area without running water or electricity (or roads). We were given strict instructions not to put anything in our mouths while interacting with patients – no gum, no tic tacos, no mints, nothing. “These people are hungry,” we were told by Evelyn Puello, our fearless team leader. During lunch we turned our backs to the open air doorways and still, the children lined up and watched us eat, trying to catch our eye so that they could make hand to mouth motions to us in hopes we had extra food. This community is living in dire poverty in one of the hottest, driest areas of the country. The area is three hours by all terrain vehicle to the nearest hospital. Of course, the only all terrain vehicles we saw in the community were mopeds, which the Haitians pilot fearlessly over roads most Westerners would fear to travel by Land Rover. Most of the people we helped were farmers, take a look at the photos and imagine trying to grow your food in an area like this.  The people we saw were in surprisingly good health considering the conditions that they live in, where extreme scarcity is the norm. The community was very interconnected socially – their very survival depends on their ability to navigate help and resources within the community. One observation from this experience that will live on with me: people who are forced to live without access to health care have a completely different perception of what feeling pain means, or various other symptoms. In privileged countries people with access to healthcare can visit the doctor for any ailment almost immediately, and they do, for any small ache. In Haiti we saw a child with a raging middle-ear infection on both sides. When we asked her if she had ear pain, she said she did not. When pressed, she said that she maybe sometimes had pain — although we saw her wince during the ear exam. For this child of approximately seven years of age, pain is already the norm and nothing noteworthy. This changes the way you interpret answers from patients living in poverty both at home and abroad. We also saw a woman who had for years thought she was deaf, and to her amazement her hearing was restored after we removed a foreign object the size of a peanut m&m and an additional wax plug the same size (probably her body’s attempt at surrounding the object so that it wouldn’t cause infection). She can’t just run to the doctor, she was living with this condition for years, thinking that the condition was worsening to the point of not return. But she has to go on, and so she does. The woman was in her 80s but she was smiling like a child when she left the clinic.

In the Dominican Republic we worked in urban slums under a bridge in Downtown Santo Domingo. We saw many people with afflictions related to the contamination of water both from the city and the river. In general people had more regular access to medicine, and were better fed. We saw less conditions that had been ongoing for years, still many had been afflicted for weeks or months. On the Dominican side of the border there is public healthcare, but many people choose may not see the point of getting a diagnosis if they won’t be able to buy the medicine anyway.

This trip was a powerful reminder of all that we take for granted. Clean water. Access to food. Access to an economic system that allows us to earn enough money to buy food. Education. Stability. Opportunity to change our own destinies. The freedom to help those who need it. The assumption that our children will live. The assumption that we will live.