In 2019, Rush conducted a Needs Assessment for Villa Verde, Dominican Republic using a previously Rush IRB approved survey of Jerusalem and a USAID validated household questionnaire. 323 households participated voluntarily and all participants were de-identified. Based on findings, we know opportunities exist for improving food insecurity, increasing access to water, improving access to primary care, and education on hygiene, smoking, and water safety. Significant findings include: 

• 52% of households reported "Going to sleep hungry" at least once, 60% reported "Had no food to eat" at least once, and 37% reported "Gone day and night without eating" at least once over the past 14 days when the survey was conducted.

• 97% of households have concerns about not having enough drinking water. Water is obtained through a communal pipeline for 26% of household, rain water for 25%, and delivery trucks for 40% of households. 17% of households "do nothing" to make water safe to drink.

• 47% of households report transportation has prevented them from seeing a physician in the past year. At the time the survey was conducted, over the previous year, 9% of households received medical care from a primary care physician, 14% from a public health clinic, 15% from a private hospital, and 63% from a public hospital.

• With regard to hygiene, 91% have access to face coverings, 67% wash their hands when returning home, and 64% wear masks when interacting with non-household members.

• 13% of households have someone who smokes, and 51% of those households have someone that smokes inside.

Current initiatives underway include the construction of a primary care clinic slated to be completed by end of summer 2021. Given the lack of transportation and public hospital use as primary care, the clinic will provide a central, accessible location for approximately 10,000 people.  

Future initiatives will revolve around enhancing the community pipeline, testing the water and creating a water purification system, and developing a water kiosk. The potable water will be sold at a price the community can afford. To address food insecurity, during COVID, we worked with community leaders to identify and distribute food to those most in need. Moving forward, we will work with providers to refer those with food insecurity to community leaders and possible resources. We will continue to work with community leaders and government officials to make public transportation and healthcare more accessible for Villa Verde.  

Education initiatives will include hygiene, water safety, smoking cessation and harm reduction, communicable and non-communicable disease prevention, transmission, and progression. 

Abstract

Purpose

The Global Health Program at Rush University Medical Center has recently partnered with a community outside of Santo Domingo, Dominican Republic, called Villa Verde to provide medical care.  To better understand the medical challenges of the community, we conducted a health inventory survey to characterize our population and assess preventable health disparities.

Methods

Study Design: Our study took place in Villa Verde. Survey questions were adapted from a previously Rush IRB approved survey of a Haitian community and a USAID validated household questionnaire. Villa Verde community members administered the survey.

Participants

We selected households to participate in our voluntary survey using stratified random sampling of every 3rd home, on every other street within Villa Verde. Selected surveyors consented the self-identified head of the household prior to completing the questionnaire.

Analysis

All participants were de-identified. Coded questions were uploaded to Redcap for data entry and interpretation. We collected information about  demographics, barriers to obtaining healthcare, vaccination status, past medical histories, and an assessment of health literacy.

Findings

323 Households consented to be part of the project.  We found that a large majority of households are concerned about having enough drinking water and sizable segments were concerned about food and transportation.  We also were able to obtain household prevalence of certain diseases.

Introduction

Rush University Medical Center’s Global Health Track emphasizes community partnership as a means to provide sustainable and effective primary care medicine. In 2003, Rush initially partnered with the village of Peralta in the Dominican Republic via local US-based non-profit Community Empowerment. Through collaborations with community leaders, identifying local healthcare needs, providing primary medical care, and creating a profitable water filtration system, Rush helped the city of Peralta to develop an economically sustainable medical clinic. 

In an effort to continue serving the people of the Dominican Republic, Rush has relied on its local contacts to identify another community in need. The city of Villa Verde is small rural village 45 minutes north of Santo Domingo. The village consists of approximately 3,500 homes with poor sanitation, unreliable electricity, poor access to public transportation and no local medical clinic. In 2018, Rush partnered with their community leaders and began providing primary medical care to the community every three months. However, in an effort to more deeply serve the community, Rush’s Global Health Track has undertaken a Community Needs Assessment Survey. The goal of our survey is to better understand the demographics, medical needs, and barriers to healthcare in the city of Villa Verde.

Methodology

Our needs assessment survey was based on a previous Rush IRB approved survey administered in Haiti, as well as a United States Agency for International Development (USAID) validated household questionnaire. The survey questions were translated into Spanish and received Rush IRB approval as well as approval from elected community leaders in Villa Verde. Selected surveyors from the Villa Verde community randomly sampled every 3rd home on every other street within Villa Verde. The self- identified head of the household verbally completed the survey. We used openepi.com to calculate a sample size for a 95% confidence interval. 

A total of 323 surveys were completed. All information was de-identified, and securely entered into Redcap. The data for this project was analyzed using Redcap data tools for preliminary descriptive characteristics. 

Results

Community leaders from Villa Verde approached each selected household and no households declined to participate.  We received a total of 323 surveys from the Villa Verde (VV) community, including information of 1165 individuals. Each household had an average of 3.8 people living there. 50.7% of the members were marked as male and 49.3% female. No individuals were identified as non-binary.  The mean age was 26.7% of the household members.   

• 96.7% of households surveyed were concerned they did not have enough drinking water. The largest source of water (39.6%) noted was delivery to VV households by delivery trucks (in large botellones), while 26.2% was delivered from piped water sources onto individual property, and 25.2% was rain water. The preferred water treatment system was bleach/chlorine (54.7%), however 16.8% of the respondents do not treat their water.

• With regards to food, over 60.2% had no food at least once in the two weeks preceding the survey and 52.4% of our sample reported going to sleep hungry at least once during that same time period.

• For transportation, 57.2% of VV households use public transportation as their primary mode of transportation, 22% use motor bikes, 20.1% walk, and 16.4% use an automobile primarily. Over the past 12 months, 47.4% of those surveyed could not see a doctor at least once due to transportation issues.

• In terms of available technological resources, 68.2% of households surveyed have electricity, 34.1% have internet access and 14% have computer access.  Seventy percent of households have at least one mobile phone, however 69.2% have limited internet access due to poor connection and lack of available minutes.

Discussion / Conclusion

While discussing our data, it is helpful to interpret trends in the context demographic data, future public health initiatives, and educational initiatives. Based on our demographic data, we have extrapolated that our population consists of approximately 10,000 people in size, with broad distribution of age groups.  The burden of disease most affecting our community seems to be cardiac disease, musculoskeletal complaints, kidney disease, and lung disease.  This information will be vital in sufficiently stocking our pharmacy to cover an appropriate spectrum of disease.

With regards to future public health initiatives we will need to address water insecurity, food insecurity and transportation issues. One of the exciting community endeavors recently undertaken by Villa Verde was the construction of a water pipeline into the community. This civic project provided accessible and cheap water options for the community. Currently the pipeline is only accessed by approximately 26.2% of the community. Our future public health initiatives will revolve around enhancing this pipeline, testing the water, and promoting its distribution to the entire community.  To address food insecurity, we are working with community leaders to identify and distribute food to those most in need. Given lack of transportation access as a barrier to healthcare, creating a clinic within Villa Verde would be ideal. We will continue to work with community leaders and government officials to make public transportation and healthcare more accessible for Villa Verde. 

Lastly, our survey has helped to identify several educational initiatives to improve community health. Hand washing and mask wearing campaigns will be vital. Furthermore, anti-smoking campaigns will help with the burden of respiratory disease.

While our involvement in Villa Verde thus far has been brief, obtaining this Community Needs Assessment Survey is an integral first step in better understanding our community. This information will enable us to have targeted interventions to help the community. We will continue to strategize with community leaders to create a long-term infrastructure with the goal of Villa Verde to become financially and medically self-sufficient.