Healthy Schools and Professional Development: Experiences in the Dominican Republic.

by Colleen MacLean Davison

Gro Harlem Brundtland, the Director General of the World Health Organisation (WHO) once said, “The need is for local as well as national solutions. Above all there must be collaboration in the world-wide community. The world is interdependent and those problems afflicting great segments of the planet have consequences for other countries and for their people as well.”  As I come to work each day as an intern at the Pan-American Health Organisation (PAHO), in Santo Domingo, Dominican Republic, I strive to take  Ms. Brundtland’s words to heart.

I was initially drawn to this internship position, under the Youth Internship Program funded by the CIDA, because it involved work in a regional office of the World Health Organisation (WHO).  My interest was sustained, however, by the description of the project, “ … to liase with PAHO/WHO, the Ministry of Health and the Ministry of Education to help facilitate implementation of  the national Healthy Schools project. To develop tools for teacher training, develop joint work plans, find creative solutions to local problems and publicly promote the Healthy Schools project.” I was hooked! I knew this internship position could be an amazing learning experience and networking opportunity for me.

The transition from Canadian life to work in the Dominican Republic demanded adaptability and keen observation skills. At first, it felt as if I had been tossed overboard and was learning to swim.  Although I felt it essential that I show my co-workers and mentor, Dr. Oscar Suriel (shown in picture), just how enthusiastic and dedicated I felt toward the project, I also needed time to become familiar with my new circumstances, including a new office environment, new faces, new activities and expectations,  and a new working language. On occasion, these factors combined to produce a feeling of being overwhelmed, but time is a wonderful teacher.  I made a point of greeting everyone I passed in the office and smiled at every opportunity, I prepared simple conversations ahead of time in my head just to break the ice, and I never said ‘no’ to any opportunity to get to know my co-workers better, even if I was tired at the end of a day. I had to work hard to be viewed as one of the team but it was worth the effort and I slowly began to take on, and was comfortable with, more responsibility. I feel I have comfortably adjusted to the steep learning curve that assimilation into a new culture and language demands. This is, of course, an on-going process.

Challenges come in many forms in my job here in Santo Domingo. Some days I feel isolated by cultural and language barriers; other days I am frustrated with the seemingly slow progress of office procedures and necessary levels of administration, even as I realize these come hand in hand with work in a governmental organisation as large and influential as PAHO/WHO.  The greatest obstacle for the Health Schools project at the moment is the development of an effective working relationship between the Ministry of Education and the Ministry of Health. A large part of my job here in the Dominican Republic, is to encourage this co-operation and work with these Ministries to help amalgamate the work done in both sectors so that it leads to the ultimate goal of efficient resource use for a healthier school population. This is a challenge which takes creativity, hard work and diplomacy, but I see this goal as worthy of the effort it may take to achieve it.

Along with challenges also comes a whole wonderful set of opportunities. Being a PAHO/WHO intern hosted by the Canadian Society for International Health, has been instrumental in helping me develop a network of health promotion professionals who I now call my colleagues and friends. I have visited local villages and schools, and have been able to follow one community, in particular, through the process of capacity building and its declaration of a “Healthy Municipality” under WHO initiative. This ‘hands-on experience’ gives meaning to my university-based theory , puts faces on the “target population” and gives me the true feeling for what health and development work is all about. It has been uplifting to see doctors and nurses talking with teachers and politicians, successfully reaching some consensus on what priority health issues exist in their local areas. We are attempting to find solutions together.

As an intern at the PAHO/WHO national office, I have been able not only to witness projects first hand, but to assist in their conception, development and eventually their evaluation. The main goal of our Healthy Schools project is to ensure that schools in this country are healthy settings for learning, living and working. As I visit local schools and talk to both adolescents, their parents and teachers, I am able to understand how the workers at PAHO/WHO, and other related agencies, are able to stay motivated to improve the public’s health. Some problems are more easily solved than others. The answer to concerns pertaining to sanitary services, water availability and purity, and other environmental or infra-structural aspects of a school, for example, may be focused attention and the allocation of resources. A project team from the World Bank, in co-operation with the Ministry of Education (Infrastructure Section) and local communities, are completing a school environmental census this year throughout the Dominican Republic. This project will help provide necessary water filters, light fixtures, paint, sanitation and cleaning services. This work aims to be sustainable in that the stages of the project are cyclical and through routine maintenance, vigilant care and repair of existing services, environmental concerns such as these may no longer make up the most significant worries of those in the school community. This provides an important starting point for our Healthy Schools project, as it is essential to ensure a safe physical environment, conducive to learning and to health, before other concerns can be addressed.

The Healthy Schools project in the Dominican Republic is an example of a project which is attempting to make maximum impact with minimum cost. It aims to find sustainable solutions in co-operation with local people. Over the next three years, hundreds of teachers will be trained and curriculum changes will be made to further promote health in schools, a basic health census will be completed for all students this year as well. The Ministries of Health and of Education hope to become strong partners in improving school health services and developing positive physical and psycho-social environments in schools.

In direct relation to my position as Intern with PAHO/WHO in the Dominican Republic, I was able to attend the first meeting, and creation, of the Caribbean Network of Health Promoting Schools. Being able to attend this conference in Bridgetown, Barbados, is a clear reflection of the exceptional professional benefits this internship has provided me. Members from over fifteen countries in the Caribbean met and shared experiences during a four-day conference in beautiful Barbados. I made contact with people who were experts in the area of School Health, and have direct experience with these types of projects in neighbouring countries. I found it invaluable to listen to the reports of health promotion officers who are in various stages of development, implementation and evaluation of their own national Healthy Schools initiatives. I was able to discuss our project in the Dominican Republic, and bring much information back to my co-workers at PAHO/WHO in Santo Domingo. I feel my attendance was important in helping guide the success of our project here and I know I am a very valuable member of the Dominican Republic’s Healthy Schools team.

Following this six month internship I have decided to continue my involvement in Healthy Schools by studying one aspect of the initiative for PhD research in Canada. I feel that having the opportunity to work at PAHO/WHO, as part of the CIDA Youth Internship Program, has made a significant and lasting impact on my professional development and future career.

Colleen - Dominican Republic, 2001-2002