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Copyright by Brenda K. Wilson 2019 The Dissertation Committee for Brenda K. Wilson Certifies that this is the approved version of the following dissertation: AN UNRULY MÉLANGE IN A POSTCOLONIAL STATE: THE CULTURAL POLITICS OF GLOBAL HEALTH ENGAGEMENTS IN DOMINICAN REPUBLIC BATEYES Committee: Arlene Macdonald, PhD, Supervisor and Co-Chair Rebecca Hester, PhD, Mentor and Co-Chair Jerome Crowder, PhD Matthew Dacso, MD Lawrence Loh, MD AN UNRULY MÉLANGE IN A POSTCOLONIAL STATE: THE CULTURAL POLITICS OF SHORT-TERM GLOBAL HEALTH ENGAGEMENTS IN DOMINICAN REPUBLIC BATEYES by Brenda Kay Wilson, MA Dissertation Presented to the Faculty of the Graduate School of The University of Texas Medical Branch in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in the Medical Humanities The University of Texas Medical Branch March, 2019 Dedication To my daughter, Kaela, and other youth who, like her, choose to speak truth to power rather than sit back and remain silent. Acknowledgements Fully acknowledging the many people who supported this dissertation and my more than six years in graduate school is not possible; however, there are several people who deserve special mention. First, to the people living in the Dominican bateyes, there would be no dissertation without you. I am forever indebted to you and thankful for your willingness to share your experiences as part of this research project. Through the telling of your stories, you have taught me so much about your lives; you will always hold a piece of my heart. I also owe debts of gratitude to my quadrilingual research interpreter, Marie- Ange Magliore. I am truly grateful for your tireless assistance, your invaluable knowledge on the histories, cultures, and politics of Haiti and the Dominican Republic; your passion to learn about life in bateyes; and for your enduring kindness and friendship throughout our fieldwork in the Dominican Republic – from our long and hot days spent in the bateyes and memorable discussions over dinner in La Romana, to the cold and damp adventures on the streets of old Santo Domingo - I am forever in your debt. This dissertation was made undeniably better with your input and expertise. Rebecca Hester, Arlene Macdonald, Jason Glenn, Jerome Crowder, Matthew Dacso, and Lawrence Loh have been the advisors and mentors that every doctoral student hopes they find. I consider myself one of the luckiest graduate students at the University of Texas Medical Branch for having had the opportunity to be co-advised and mentored by Rebecca Hester and Arlene Macdonald over the past six years. Rebecca Hester introduced me to the critical theories that underpin this research, inspiring in me new ways of thinking about the effects of power and politics on health and human flourishing. Arlene Macdonald was a continuous source of positivity, providing intellectual guidance and grounded feedback, while also being there for me through one of the most difficult times in my personal life. Jason Glenn has been one of the most influential people in my life, showing iv me the importance of taking up a “history of the present” to understand how health inequities are constructed by relations of colonial, neocolonial, and neoliberal power. His writing and teaching have inspired me: always knowing just when to challenge me with difficult questions, when to offer encouragement, and always with a sense of humor. I would also like to thank Jerome Crowder for his guidance on using critical ethnography and photography in qualitative research, which has undoubtedly enriched the ways I was able to engage the lives and work of cane cutters and other respondents. Matt Dacso was always willing to meet with me and gave me the crucial support necessary for this study to take place, making sure a smooth transition into the Dominican Republic even before the onset of my fieldwork. Likewise, I am grateful to Lawrence Loh for taking a chance on a graduate student he had only just met. His work has influenced how I think about education, advocacy, and social justice in STGHE. I would like to express my deep gratitude to the staff of the La Romana host organization, from the leadership, physicians, and nurses, to the interpreters and mission house workers. All were so generous with their time, energy, logistical support, kindness, and warm hospitality. Thank you for welcoming me. I am truly grateful. To the numerous students, program facilitators, and other respondents: thank you for participating in this research, for your friendship, and for the countless memorable experiences. I would like to acknowledge the Institute for the Medical Humanities for intellectual and financial support in the form of assistantships and scholarships. I am also thankful for the Jeane B. Kempner Fellowship Award for helping to support this research project, as well as for the Arthur V. Simmang Scholarship Fund and the Harry Huntt Ransom Fellowship Award in the Medical Humanities. A special thank you goes to Rebecca Rubinstein for helping me ease into La Romana, introducing me to key informants, and for sharing her valuable insights on STGHE and bateyes. Thank you to my fellow medical humanists – Erica Fletcher, Jonathan Banda, Imanni Sheppard, Shannon Guillot-Wright, and Amerisa Waters – for their v friendship and for creating and maintaining a rich supportive and intellectual community that I have been privileged to be a part of during my time at the Institute for the Medical Humanities. I am also grateful to Javier Allende-Labastida and Sergio Rodriguez for their friendship, encouragement, and memorable Global Brigades experience in Honduras. Premal Patel, Caley Satterfield, Christine Kovic, and Jason Rosenfeld have also helped with research questions and supported me throughout this journey. A special thank you goes to Clifton O’Neil whose lived experiences have made me acutely aware of the health consequences of racism in our society. And of course, my best friend for more than 20 years, Jennifer Boyer: thank you for your endless optimism, contagious laughter, and for always keeping me sane. Finally, in an effort to express the inexpressible to my mom and dad, whose unconditional love and support has sustained me. This has meant the world to me. I didn’t always know it or couldn’t quite put it into words until graduate school – but it was you who taught me that the personal is political; you have shown that to me by example. Thank you for always being there for me, and for never discouraging my wild adventures even though I know you worry more than you let on and keep you wondering where I’ll go next. I am grateful to my brother, Matt, for always being there for me, and for being one of my best friends through all the good, bad, ugly, and beautiful. To Dennis, who has been my rock through these past years, despite all my faults. I know this dissertation wouldn’t be possible without you and your endless patience and love! Thank you for trying to keep me grounded, for not letting me give up, and for being there through the laughter and tears that were poured into this project. And last but never least, to my sweet daughter Kaela: you have brought a joy to my life that I did not know was possible. I continue to be amazed by the kind, intelligent, loving, passionate, beautiful human being that you’ve become. You inspire me every day, and I love you something fierce. vi An Unruly Mélange in a Postcolonial State: The Cultural Politics of Short-term Global Health Engagements in Dominican Republic Bateyes Publication No._____________ Brenda K. Wilson, Ph.D. Candidate, Medical Humanities The University of Texas Medical Branch, 2019 Supervisors: Rebecca Hester and Arlene Macdonald In order to understand the implications of short-term global health engagements [STGHE] for ethnic-Haitian im/migrant sugar laborers and their families living in Dominican Republic bateyes, this ethnographic study uses a critical humanities approach to examine the cultural politics of STGHE, illuminating the epistemic forces, social dynamics, economies of exchange, and relations of power taking place through STGHE. Bateyes are the impoverished residential sites located on Dominican sugar plantations and are known for having some of the worst living and working conditions in the world. This research asks how and why illness, poverty, and inequities in bateyes persist, despite more than three decades of STGHE involvement and growing attention to global health. Given the increased recognition of the importance of training a future global citizenry and/or global health workforce how to understand the social and structural determinants of health inequities and how to take action on them, I question how health inequities are experienced by batey residents on an everyday basis and how their experiences articulate with STGHE programs purportedly aimed at addressing health inequities. Drawing together critical theory and one year of multi-sited ethnographic fieldwork, I examine how the root causes of batey health inequities are taught, learned, and intervened through STGHE. I posit that the root drivers of health inequities in bateyes are historically-rooted and sociopolitical; however, numerous depoliticizing techniques built into STGHE obscure those underlying historical and sociopolitical reasons batey residents suffer illness and poverty in the first place. This mismatch reveals how STGHE may not address health inequities and, given the way that power is operating through STGHE, may unknowingly perpetuate or exacerbate unequal power relations, albeit through hidden epistemological, ideological, institutional, economic, and political processes. I conclude with an alternative pedagogy and practice for bringing STGHE closer to realizing their aspirations of achieving health equity. vii TABLE OF CONTENTS List of Figures .............................................................................................................xii List of Abbreviations ...................................................................................................xiv AN UNRULY MÉLANGE IN A POSTCOLONIAL STATE: THE CULTURAL POLITICS OF SHORT-TERM GLOBAL HEALTH ENGAGEMENTS IN DOMINICAN REPUBLIC BATEYES ..1 Chapter 1.
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