Complexities of Cholera in Tilori, Haiti: A Day in the Life

Complexities of Cholera in Tilori, Haiti: A Day in the Life

Dr. Autumn Quezada de Tavarez

Assistant Professor of Latin American History

Roger Williams University


There are many health concerns in Haiti – clean water, sanitation, a severe lack of medicines, a general infrastructure, AIDS, chronic diseases and communicable diseases. Of the many aliments fevers, dysentery, tropical diseases such as dengue, and respiratory illnesses rank the highest. However, TB and cholera have the potential to be most deadly.

Dr. Paul Farmer, physician and anthropologist, devotes most of his energies through the Boston based Partners In Health to treat and contain TB and cholera. Farmer in his notable study titled Infectious Diseases and Inequalities cites that Tuberculosis is a global epidemic and the leading cause of death – “stupid deaths” he calls it. Treatment and monitoring can help to stem that epidemic. Between the years 2012 and 2013, Tilori had over 200 confirmed cases of TB – a town of 17,000+ persons. Meanwhile, cholera is a daily threat to the majority of populous in Tilori, as it affects peoples of all ages.

Tilori, Haiti sits on the border opposite the Dominican town of Restauracion in the Department of Dajabon. A visit to the town of Tilori on market day offers the few visitors an opportunity to experience the town at it’s busiest. A walk through town is an exercise in chaos. Haitians from nearby towns bring their wears ton horseback and via mules to town to sell, exchange and barter. However, beyond this façade is a deeper experience; one of health. Dusty roads filled with sharp rocks present also as streams of sewage. Children run barefoot through water infested with E. Coli and excrement. Living in such close proximity poses the severe dangers of contamination that develops into cholera. The greatest danger of cholera is dehydration and a shortage of hydration salts poses an enormous mortality threat.

On this day, in January our guide, educator and town leader Tete weaves us through the roads to visit schools and clinics.

I ask Tete: “When was the last case of cholera?”

His response in Spanish: “We are in the time of cholera. Last week we had eight cases. One died, but seven survived. Gracias a Dios.”

Tilori houses one hospital with one doctor and one nurse to serve over 17,000 inhabitants. That’s an incredible imbalance to consider. The main hospital houses three rooms: one consultation room as a line of people awaiting consultation; a maternity room for birthing; and a filing room. The consultation room has less than ten operating beds.


The birthing room has three birthing beds.


Separate from the main hospital is the house specifically devoted to cholera containment. This wooden structure has three rooms with a number of wood beds with holes and a bucket beneath to catch the copious amounts of liquid excrement from each patient. On this day there are no patients and we are instructed to touch nothing. This is a dangerous infectious disease. In the entry way are large spray bottles to disinfect the building daily with special chemicals to clean the crude hospital. One can only image the horror of cholera when the hospital is filled with patients suffering or near death.


It is difficult to imagine a community as large as Tilori living with the daily reality and horror of cholera, a disease brought recently by UN workers. This is their reality – a reality beyond the human catastrophe of the earthquake of 2010 with killed over 400,000 people near the capital leaving hundreds of thousands of children orphans. Many fled the capital for the frontier with the Dominican Republic.

Haiti is an incredible nation of peoples strong with a will to live, to survive. As the poorest nation in the western hemisphere, one is struck simultaneous will to live, survive and prosper in the face of governmental impotence and mismanagement. Dr. Farmer famously posited a thesis known as “structural violence” which helps us to understand the situation in Haiti and in other places where peoples are forced to survive in the face of tragic governmental neglect. Despite this neglect, Haitian education is excellent – in French, Kreyol and English. An enormous feat being that they have no materials for student in the classroom. This speaks to the strong will of Haitians. Yet it is hard to not recognize how this structural violence robs people of their human dignity. Children beg – “Dame un peso.” Or they sell themselves.

The tragic story of Haiti is both one of severe neglect. Yet other stories need to be told. There are many Haitians pushing grassroots programs both with outside NGOs as well as amongst themselves to improve their situations. What do you do when you cannot count on the government to pull its weight? People take the imitative as best as they can with what they have. This is the story of Haitian people, a strong people – survivors in the face of insurmountable obstacles. These stories MUST be told.









Social Justice in Hispaniola is an interdisciplinary 6-credit course offered during the Winter Session of the school year at Roger Williams University. This course is a collaboration between three professors

Dr. Paola Prado (Journalism/Film/Communications)

Dr. Autumn Quezada-Grant (Latin American History)

Dr. Kerri S. Warren (Biology/Public Health)

These three professors rotate out the course offering pairs each year offering students an interdisciplinary experience that is both exciting and engaging.

Our teaching and learning methodology is a mix of experiential learning, service learning and fair trade learning with our community partners in the Dominican Republic.


About our study abroad

HIST 338 Social Justice in Latin America: Hispaniola

Department of History and American Studies

Prerequisite: HIST 100 (for Majors), or consent of instructor

Fulfills a course requirement in the History Core Concentration and for the Latin American and Latino Studies Minor; 3-credits


Winter Intersession 2016. January 2-16, 2016             Location: Dominican Republic

Instructor: Dr. Autumn Quezada-Grant                        Email:

Office: GHH 213                                             Phone: 401-254-3024



Course Description: This course will be taught on the island of Hispaniola and will focus on the country of the Dominican Republic. During this Study Abroad experience students will explore issues and histories in Latin America related to social justice. Evolving over the last two decades, there has been a rising tide of responses by everyday citizens in Latin America to problems related to income disparity, violence, corruption, education reform, public health, revolutionary movements, globalization, and neoliberal policies. The legacy of Liberation Theology (post-1962) has prompted citizens to reflect on their lives in relation to powers above and to consider action. Social Justice offers us a lens in which to understand the nexus of lived experience and the challenges of making a just world. This class offers students an opportunity to think about the context of history in relation to lived experience and how individuals and communities negotiate from below and within. Readings and discussions will revolve around historical narratives, local voices, gendered histories and constructions of race and class.


Course Goals: Students will gain a depth of knowledge in the history of Hispaniola within a cultural context: readings and lectures will broaden student’s understanding of the island and the historical friction between the Dominican Republic and Haiti, as well as the specific history of the Dominican Republic which involves colonial legacies, US involvement impact and dictatorship. Students will be introduced to issues of social justice by witnessing it first hand in the country. Students will visit communities and talk with locals about current issues. Students will gain knowledge from our companion course PH 430: Special Topics in Public Health about blending studies in public health tied to income inequality to understand social justice. While students gain experience through citizen journalism, this history course will help ground the students with a depth of historical knowledge that will aid them in crafting thoughtful questions and project ideas. Students who successfully complete this course will be able to:


  1. Articulate a broad history of the island of Hispaniola.
  2. Identify specific social justice issues within the Dominican Republic that is sensitive to and inclusive to local viewpoints.
  3. Understand how to incorporate a sensible grounding in recent history to craft interview questions.
  4. Accurately discuss local responses to social justice issues within the Dominican Republic.
  5. Engage with local communities in the production of their course projects.
  6. Learn how to use a multimedia website for the sharing of documents and projects required of the course. 

Course Requirements and Grading:


Students are expected to prepare thoroughly for class by reading assigned material before our study abroad experience in order to discuss, participate and for preparedness for community work. The final grade will be computed as follows.


Group Discussion and Participation on-site (20%) Students will become conversant in the broad outlines of history of the island of Hispaniola – colonial and national periods. We ill have lectures, guest speakers and cultural site visits. The history will include periods of intervention, invasion, dictatorship and economic development. We will also discuss issues revolving around race, stateless peoples, immigration, economy, natural resources, public health and education.


Photo stills (20%) Students will be required to shoot individual digital still imagines that will be used to populate the multimedia site and blog posts. Each student will be required to publish a minimum of ten still images each day that accurate report the material explored in each course, for a total of 100 edited still shots. This assignment will over lap with your assignment for the public health class.


Blogs (30%) Starting on the eve of departure and ending on the day of departure from the Dominican Republic, each student is required to write a considered analysis of the course materials covered that day. These entries will coordinate with photo images that you turn in for your journalism class. Your entries should reflect on the connections you learn that tie theory to praxis (classroom learning to lived experience). Each blog should explore of questions and reflections. Your blog will be due to me each night and will include at least one photo from the day. I need to read them to help facilitate questions for the following day.


Comprehensive Exam (30%) At the end of the trip, each student will analyze and explain the relationship between history and social inequalities in the island of Hispaniola in respect to the Dominican Republic. This on-site written assignment will be an exam that asks you link significant historical notes from our readings, to current issues and be an over all reflection of your learning.

Required Readings:


Michele Wucker, Why the Cocks Fight: Dominicans, Haitians, and the Struggle for Hispaniola (Hill and Wang, 2000)


Binder of selected readings will be provided in a bound volume.



Film: In the Time of Butterflies

Documentary: Black in Latin America – PBS film series hosted by Henry Louis Gates


PH 430: Perspectives in Public Health: Dominican Republic (3 credits)

Prerequisites: PH201, or consent of instructor

Fulfills a course requirement for the major in Public Health

Winter Intersession, January 2-16, 2016                                                                Dr. Kerri Warren (

Associate Professor of Biology

Office: MNS223 Phone: x3481

In coordination with The Foundation for International Medical Relief of Children


Companion Course: HIST338 Social Justice in Latin America: Hispaniola (3 credits)


This faculty-led short-term study abroad course introduces students to public health in the Dominican Republic in the context of Hispaniola’s history, people and specific social determinants. The course will explore the infrastructure and delivery of health care and health issues specific to the Dominican Republic, as they interact with historical structures of inequity, poverty and marginalization. In coordination with companion class HIST338, students will evaluate the social justice ramifications of the convergence of social and biological impacts on health.


The course will be taught on the island of Hispaniola, with visits to significant historical and cultural sites and a variety of distinct health care settings. We’ll also complete a concentration of work with community members, leaders, health promoters, healthcare workers, educators and students in Restauracion. The community of Restauracion is situated in the second poorest province in the Dominican Republic, just 12 KM from the border with Haiti, with a complex past and present relationship with their Haitian neighbors. There are five clinics in the vicinity that rely on the public health system, but funding is insufficient. Large micro-communities of undocumented citizens of Haitian decent lack any access to health care or preventative education.


The Foundation for International Medical Relief of Children (FIMRC) operates a clinic and public health support system in Restauracion with a dedication to addressing the needs of the community. FIMRC will provide the infrastructure to our public health service in Restauracion, and this access will provide a critical link between our classroom learning and engagement with real-world public health.


Learning Objectives:

Students who successfully complete this course will be able to:


-Connect historical events to structures affecting health in the Dominican Republic

-Participate in global health service, and communicate experience in writing

-Work together in an interdisciplinary team

-Engage with cultural differences, both within the country and between themselves

-Demonstrate an understanding of the lived experience in DR

-Illustrate the interdisciplinary nature of global public health

-Identify social and biological factors related to health and disease in the DR

-Describe the organization of the DR’s health systems and its evolution

-Apply the public health approach (problem, cause, intervention, implementation) to a new public health problem

-Explain how Public health efforts can utilize health information/communication to improve population health

-Systematize information collected during service in a written analysis.

-Integrate the multi-directional links between health, social and economic factors     in the Dominican Republic



Class Participation: Each student is expected to contribute to class discussions and to fully participate in activities, workshops, and presentations in the communities. This is a rigorous course that is reading, writing and experience-intensive. Expect to spend time preparing for, and reflecting on, the events of each day.


Access to Equipment: Each student must bring a laptop and a thumb drive for uploading photos taken on course-provided cameras. A journal (for hand-written entries) will be provided to you.


Mutual Respect: Roger Williams University is an institution that prides itself on presenting an environment that exhibits and encourages tolerance. This class is no different. REMEMBER you will be in a different country and must demonstrate respect for those who are welcoming you into their community and homes.


Academic Honesty: Academic integrity is required. Students, do your own work, use you own words and cite your sources. Plagiarism will not be tolerated and will result in an “F” for the course and a trip to see the Dean.


Student Health Statement: The fieldwork associated with this course includes potential exposure to the elements, flora and fauna of the island. If you suspect that your involvement in these activities may compromise your health, consult health services before participating.



20%    Individual Participation in Group Discussions and on-site activities, including community work and presentations with


5%      Workshop I Assignment ( Travel Ethics and Responsibilities)

5%      Workshop II Assignment ( Practical Health Training)

40%    Public Health Portfolio:

  • Daily Photo Artifact + Blog/Journal Entry (at least 5 of the 14 entries demonstrating direct integration of PH learning)
  • Critical Reflections, Guided, on service, structures, society, determinants, ecology of health
  • Written analysis of PH Issues Encountered connected Social Determinants Assignment

30%    Comprehensive Exam: Apply Public Health Approaches to a DR Challenge

Required, but not graded: Evaluation Handout and Study Abroad Survey


Contact Hours:

Pre-trip meetings: 26 hours. In early December, students will be required to attend planning meetings and one pre-trip workshop that will provide information about travel logistics, photography/blogging resources, and service learning training.


In the Dominican Republic (January 2-16): 225 hours. This time will considers class, discussion, and mandatory activities, guest lectures, etc.


Tentative SCHEDULE

PH Class topics

Jan 2,3 Basics of Public Health in the DR, Student Responsibilities and Ethics Essentials of the Case Study

Jan 4   Clinic Setting, lecture and clinic service

Jan 5    Determinants of Health- Demographics, Society, History, Poverty

Jan 6   Public Health Approach and Policy in the Dominican Republic

Jan 7, 8 Current Health Concerns of Restauracion- Biological principles-Communicable, Non-communicable, Conditions

Risk Factors- Malnutrition, Poor Housing, Sanitation

Jan 9 FIMRC Orientation, Youth Initiatives in Restauracion-Gender Equity, Reproductive Health, Empowerment

                  Cultural and historical tour of Restauracion, including meetings with the Hospital Staff and Local Government, Lecture

on local initiatives –   Environmental Health, conservation, forestry and sanitation-

Jan 10 FIMRC-coordinated Service Learning and tour of the clinic, community needs assessment, Group assignments,

preventative health activity with      elementary school children, community ‘rounds’ with physician

Jan 12 Service and shadowing (Physician in Clinic, Public health Ministry official in community) Preventative health discussion with young adults, young parents Youth Initiatives- Interaction with leadership groups- Super Man and Wonder Woman

Jan 13 Community house calls, data collection or health screening, health education, Community visit with health care

workers- Cholera, chikungunya, etc prevention Grade school project. Help coordinate and collect data on height,

weight and general sight ability.

Jan 14 Clinic Improvement project, summary and brainstorming with FIMRC

Jan 15 Final Exams

Jan 16 Travel Day, Reflection and Discussions

Jan 17 Online –final entries, portfolio wrap up



Active participation in learning

This study abroad experience at Roger Williams University was the brain child of Professor Paola Prado (Communications), Professor Autumn Quezada de Tavarez (Latin American History), and Dr. Kerri Warren (Biology/Public Health). Our years of research and volunteer work both independently and with FIMRC (Foundation for the International Relief of Children prompted us to create unique experiential learning experiences in a learning classroom in Restauracion, Dominican Republic.

Students alternately study history, journalism, and public health conditions in both the Dominican Republic and on the Haitian border. This study abroad experience is unlike any other study abroad at Roger Williams University rooted in service learning work and fair trade learning (modeled on Amizade’s model of shared learning

Please contact us if you are interested in learning more:

Professor Paola Prado (Communication/Journalism)

Professor Autumn Quezada de Tavarez (Latin American History)

Dr. Kerri Warren (Biology/Public Health)