Diabetes in the Dominican Republic

382 million people in the world suffer from diabetes. In the Dominican Republic, over 10% of the population has what they call azucar, ‘sugar’ or diabetes and some people say it will rise to 20%.  To be honest diabetes has never been particularly high on my radar and I don't know that much about it. I had a great uncle who had it, a second cousin and a daughter of a friend, but I have never thought of it as particularly dangerous.

That is, until I moved into the campo. Here, everyone seems to have it. In fact we are the only house in our area where no one has diabetes.

The statistics show that Dominican Republic is the 21st most affected nation with diabetes in the world. The United States is in 29th place, Canada in 51st  and the United Kingdom 199th place. The full list is here.

The reasons given for the Dominican Republic being so high up the list are firstly genetic. It is thought that Hispanics, American Indians, and black people are more likely to get diabetes than white people, and it is thought to be passed down through families as well. It can also be attributed to a sedentary lifestyle which is definitely a Dominican trait. In addition it can also be due to being overweight, and nearly 70% of the Dominican population is overweight, plus a poor diet also does not help. The diet issue is true throughout the country with a heavy reliance on white rice and root vegetables, starches which turn to sugar, and a lack of protein and vitamins. Oil and salt are also both used to excess.

To gather more information I went to talk to two of my neighbours, Leida and Jose Manuel, the latter is usually known as Sukin. He runs the local colmado and they live in one of the 8 homes which make up our campo.

Sukin and Leida are both 62 years old and have been married for 38 years. They have a son and a daughter, both of whom live in New York. Well it could be anywhere in the United States as they call the whole country New York. They both suffer from diabetes. Sukin has had it for around 18 years and Leida 14 years. They both found out when going to the doctor for other problems and the infamous Dominican medical analysis discovered they were diabetic. Sukin’s father died of diabetes related issues aged 80 and Leida’s mother as well when she was 64. No one suggested they should be regularly checked even with a family history and nor are their children being checked.

They go to the diabetes institute in Santiago every 3 months to be checked, and there they are given diet sheets. Now Leida and Sukin eat what they grow and what he has in the colmado. They eat white rice, chicken and beans, and yuca and corn which they grow. Sometimes spaghetti and avocados in season. And he has white bread delivered daily which they eat.

They told me that if they follow the diet they would starve, as it says no or little rice and no root vegetables. No potatoes nor pasta and nothing with flour in it. They are allowed one serving of rice a week and one portion of yuca a fortnight. But all they eat is rice and yuca, so the diet sheet goes out of the window. They are allowed brown rice and whole wheat pasta, neither of which are sold within 70 miles of here and even if they were, they have higher taxes so are very very expensive. They can't eat cornflakes but can eat bran flakes which I have never seen in the country. Corn, which they grow, is a no no, but they should eat broccoli, which is expensive and hardly ever available and spinach which I have never seen here.

They try their best. They do not eat sugar, so no sweet coffee, no natural juices loaded with sugar. Instead they drink packet juice or cartons and don’t bother to read the sugar content on the side.

They are both insulin dependent. Sukin buys the bottles of insulin for 100 pesos – just over US$2 – at the Botica Popular which is the government pharmacy and they last around 2 weeks for them both. They both inject twice a day. If the Botica does not have insulin, then he has to buy it from the regular pharmacy and it costs ten times that amount. Leida has a machine with strips to check her sugar levels which her son brought from the United States but she never uses it as she isn't sure how to. Sukin has never used a machine. He has had two low sugar episodes where he has fallen unconscious and had to be taken to hospital where luckily, he recovered. His sight is now failing.

Leida had her right leg amputated 2 years ago due to poor circulation and gangrene, and her sister had her leg amputated just afterwards. She is the lady we bought our house from. Leida’s other sister died 18 years ago from complications related to diabetes, including gangrene. Leida’s other leg is now being affected and she anticipates another amputation in the not too distant future. She is upset as her wheelchair has a problem with the wheels and she can't go outside the house as it will only go sideways.

There are just under 1,000 amputations a year due to diabetes in the country and 75% of those that have one limb amputated will have to have the other one too.

It seems to me that so much could be done which isn't happening. Firstly, education and those whose parents are both diabetic should be checked regularly and early in the their lives.

Secondly, the food which diabetics should eat should be available and everywhere, not just in the international supermarkets in the large cities and tourist areas. Why are brown bread and brown rice not available everywhere? And why tax whole wheat pasta and brown rice higher than white rice and pasta? There is no point in giving people a diet sheet for things they cannot buy as they are not available or if they are they are twice the price.

I am sure people somewhere are working to solve this problem but it affects so many people's lives here and so many are dying unnecessarily that there must be a solution. I just don't know what it is yet!

Unfinished dreams

It is the anniversary of my father's death in a couple of days time. He died very suddenly and unexpectedly from mesothelioma in 2005. I think about him every day, and talk to him at night when I take the dogs for a walk. I like to think he is one of the stars which are out almost every night here and are amazing as we have no light pollution. He was very supportive of me and what I did, however crazy everyone else thought I was, and the fact he spoke fluent Spanish was fabulous as he could speak to Danilo. The picture below was taken on the occasion of his 50th wedding anniversary to my mother which was in April 2005, and Danilo and I went to the party. That was the last time I saw him.

He came to visit me in the DR for a week, after I had been here about six months or so. He and I would go to a bar on the beach at night, but because the music was so loud, we would go down to the ocean and sit on a tree trunk which had been washed into the ocean by one of the tropical storms or hurricanes. After he died, Danilo went down to the ocean and brought the same tree trunk back to our house so that I could sit on it in the garden.
A couple of days ago Danilo told me to look out of the window. He had remembered the anniversary coming up and had transplanted an orchid onto the tree in front of the window where I sit. Orchids were Dad's favourite flowers. This time they are real and not plastic!

I am always receiving emails and requests for help and information about the country, and especially from ladies wanting to know about sanky pankies. So when I received an email entitled 'Any advice" I thought it was nothing new. Until I read it. It was from a lady called Kathryne who is carrying out doctoral research at Newcastle University in the UK into holiday relationships  - not quite a PhD in Sanky Pankies but not a long way off!  I thought it was really interesting. She was looking for any British person who has had a holiday relationship with a Dominican, or someone from some other countries, to take part in a survey for her doctoral thesis. You can check it out here if you would like to participate.

We had a crazy weekend with a houseful on Sunday, not only Chivirico but his grandmother, my step grandaughter who is 4 months old and Tracy, a lady I met online via the book and the blog and her husband, Jose.

Here is the grand baby who was very well behaved.

We had a great lunch of barbecued ribs and moro de guandules and then Danilo proudly showed off his prize cockerel to Tracy - as you do.

Everyone then went and gathered avocados - well enough to last a day or two.

As you know Danilo has decided to run once again for mayor in Guayacanes. His logic being that he learned a lot the last time, and that if he doesn't run again, all that hard work and money will have been for nothing. This time, he says, it will be different. It does seem to be different in that he has the support of all the key party figures such as governors and party leaders and the phone is ringing constantly day and night.

My original reaction to be honest was, oh no not again. But as time has gone on, I have realised that you cannot take away people's dreams from them. The fire he had in his belly to actually make a difference is as strong now as it ever was.

I love the fact that he is so optimistic, but I have always wanted his unwavering optimism to be tempered with a little realism. We were talking about this over dinner the other night, and I know that people brought up in poverty often dream impossible dreams, such as becoming a world class baseball player or winning the lottery. My dreams when younger were achievable - a better job, a bigger house.

Danilo dreamed of one day having a machete like his father, but never in his wildest dreams could he imagine travelling abroad or studying at university, let alone being mayor. Unfortunately dreaming is not sufficient to win elections, and although the party have confirmed that they will give him all the financial support he needs after the primaries, assuming he is then elected candidate, he needs to fund the campaign up until then which is April next year.  Actually, the way things seem to be going, the other candidates for the party are likely to withdraw even before the primaries which will mean his automatic naming as party candidate without the need for a vote.

So I am busy trying to raise money again just like I did four years ago - fingers crossed this time it will work! I will just need to talk to my father, twinkling up there in the sky, and keep the faith. Si Dios quiere, as they say here, this time he will win.

A bathroom for Miguel

Miguel is a neighbour, aged around 60 but he isn't exactly sure. He is married to Barbara, or, as they say her name here - Baybara and he is Migay. A couple of months ago he was feeling breathless and woke in the night unable to breathe. They took him to hospital where he stayed for a couple of days and was then sent home. The same thing happened again the day he was sent home, so he went back to hospital and after a few more days had a chest xray and an ECG. They sent him home again. I went to see him and checked his pulse which was racing, over 200 beats a minute. Eventually he went back to hospital where the cardiologist diagnosed heart problems and he was sent to a specialist heart hospital in Santo Domingo, the capital. They eventually operated and replaced two heart valves. He has been staying with relatives in Santo Domingo until his wound heals and he is due to return here next week.

Since he and Baybara have been away, neighbours have periodically been cleaning their house and tidying up the garden. Now they are building him a bathroom. The dream of most campo folk is to have a real bathroom and few do. Instead they have a latrine at the bottom of the garden. As latrines go, it is a nice one, painted green and with a roof as well. They also use it to store the chicken food.

I don't have a particular problem using latrines. When I was growing up we lived in a caravan and had a chemical toilet called an Elson. Unlike latrines here where the hole seems pretty deep, the Elson was just like a big bucket and you had to put a blue liquid in it. I remember hating having to go to the toilet when it got full as if you did a number 2, as mother would call it, your bottom got splashed.

The Elson man would come every Thursday to empty it, we called him Dan Dan the Elson man, and he had a little old van with a bigger tank in it, and he would just pour the contents of our Elson into his bigger tank. Anyway I digress.

As well as a latrine, Miguel and Barbara have a shower room. Well, it is a few pieces of zinc sheeting stuck onto the outside of the house with a bucket inside and a tin can for scooping the water out of the bucket.

So now the neighbours are building Miguel a proper bathroom which is stuck onto the bedroom at the side. It is made of concrete block rather than wood like the rest of the house. I am not sure why that is but all the bathrooms people build in the campos, usually using money from their kids, are made from concrete block.

As well as actually building the bathroom and fitting the toilet, shower and sink and plumbing for water, there also needs to be a septic tank. Most houses have those here as there is no mains drainage. As you can imagine it needs to be a reasonable size, so some poor Haitian chap has been digging the hole for the last couple of days. His progress though has been remarkable.

Once finished, the hole will have a concrete slab put on the top which is never to be removed. Apparently it will never fill up as the stuff that goes into it biodegrades through the walls of the pit into the garden.

I can't wait to see Miguel's face when he returns to see he has a bathroom for the first time in his life.

La Isabela

Hooray! Have new camera so normal blog service will be resumed.

Visitors arrived on Sunday. This time it was Tracy, who has been here several times from the USA and she brought my new camera with her. Also Andrea from Canada, who although she is a DR veteran had not been to the Wasp House, and Tracy's Dominican boyfriend, Mario, who I call Sniff as he is allergic to the dogs and sniffs all the time. Danilo calls him his version of Sniff, Eneef.

So Monday morning, bright and early, I rounded everyone up, including Chivirico who was here for the weekend, and off we set for La Isabela. The reason for going there was threefold. Firstly, La Isabela is the place where Christopher Columbus first set foot on the island and as that is such a momentous historical event I really wanted to see it. Secondly, as we did not celebrate Chivirico's 8th birthday at the swimming pool, I wanted to take him to the ocean and eat fish on the beach. And thirdly, I am in the middle of updating the DK Top Ten Guide to the Dominican Republic, so needed information on La Isabela, a place I had not been to.

The plan was to drive directly north to La Isabela, then from there go west to Playa Ensenada for lunch, as  there are tens of little huts right on the beach which cook fabulous fish, then home. As usual, where Dominicans or the Dominican Republic is involved, the best laid plans of mice and men.....

All went well till we had driven through the town of La Isabela. According to the map we had to turn right to reach the National Park on the coast, where the ruins of Columbus' settlement were. Only there was no right turn. So back to the normal Dominican way of asking. Not once, nor twice, but every other Dominican in sight. And as usual they tell you where to go, even if they have no idea, and every one gives you different directions. Eneef and Danilo did the asking, but almost immediately forgot the directions they were given, hence there was lots of turning round and asking someone else.

The road changed from a tarmac road to a dirt track. I pointed out that this could not be the road as coach tours went to the National Park. I was ignored. We then had to drive through a stream, carefully avoiding the cows drinking and women washing clothes, and then back onto the dirt track. Then we reached a river. Not a stream but something akin to the River Thames in London. A real, fast flowing, deep, proper river.

"No way," I said, and Tracy and Andrea agreed with me. Danilo and Eneef tried to persuade us it wasn't that deep and the vertical dirt track on the other side of the river would be easy to drive up even though we had no four wheel drive. They even got a man to wade out into the river so we could see it wasn't that deep, but as the water reached his waist, that was enough for me. We turned round and went to Playa Ensenada for an early lunch.

Playa Ensenada is a mile or so before Punta Rucia. A lovely beach with loads of little huts lining it, each one selling fresh fish and lobster.

You choose which hut you fancy, and then sit down at the tables which belong to your particular hut, lined up along the beach.

Then they bring the fish out on a tray and you pick out which one you want.

The fish is then cooked it over an open fire, the fogon and served with fried plantain chips, tostones, and fried sweet potato, batata.

It was delicious and afterwards we just sat chilling for a while looking at the view while Chivirico romped in the ocean.

So, I asked Tracy and Andrea what they wanted to do next, and they said they wanted to find La Isabela but that this time we would do it the British/Canadian/American way and not let the Dominican contingent ask every other person and lead us to an uncrossable river. So, map in hand, off we set.

We tried a variety of different routes and didn't seem to be making progress, so stopped to ask a Dominican. He said to go straight down this road, we would reach a baseball field, turn right there and we would come to a river. El Castillo, the place where the ruins are, was just the other side of the river. I asked him what the road was like and he said it was fine. I wasn't falling for that one, so asked if it was stone or tarmac.He said it was stone, but fine. I then asked if there was a bridge over the river and he assured me there was. All bases were covered.

Andrea, Tracy and I smirked at each other. We would show these Dominicans how to navigate and get proper directions. We drove down the dirt road - for a very long way, and at last reached the baseball field. Mutual congratulations all round. We turned right, and as we bumped along the road, I had a sinking feeling in my stomach. This was the same bloody road that we had taken to the river before. The men started howling with laughter. We reached the same river and I looked to my left. There was a bridge.

It just didn't have a bit in the middle! Note to self. Next time ask if the bridge goes all the way across the river.

However, it looked as if the river was a lot lower than earlier so Danilo decided to have a go driving across.

It worked, so we all climbed aboard and off we went. The dirt track on the other side of the river soon turned into a proper road which said it was heading for Luperon and Puerto Plata - further west on the north coast and the National Park was just off that road.

The National Park is well organised and there is plenty to see including the ruins of Columbus' house and the rest of the houses for the 1,500 men he brought with him.

There is a tree there which is home to owls - the first time I have actually seen them in the wild.

The guide was excellent and full of information. The part the Dominicans enjoyed the best was the cemetery where 49 people were buried, both Spaniards and Taino Indians.

And what is more, there is a real, dead skeleton of a 37 year old Spaniard who died of malaria. Apparently they can tell he was a Spaniard as opposed to an Indian as his hands are crossed across his chest.

We went to the well laid out museum, grabbed some freshly squeezed orange juice, then it was time to head for home. I asked the best way back and unfortunately the good road only went to Luperon, which was totally the wrong direction for us, so there was nothing for it but to go through the river again. Luckily, although it was higher, we still crossed it with no problem.

All in all a great day trip, well worth it, with lots of laughs along the way.