Nurse Winnie Joseph is a member of the Kalinago tribe, an indigenous group on the island nation of Dominica.

“Health is not just the absence of sickness,” said Joseph, who works at one of the only clinics within the Kalinago Territory.

Health disparities, like higher rates of chronic disease, substance use disorders, and depression, are persistent challenges, and over the years, Joseph has seen this firsthand. “We are having diabetes and hypertension at an earlier age,” in addition to cancers, she said.

For many Kalinago, addressing these issues is also more difficult. The Kalinago Territory — a 3,700-acre reservation on the eastern side of the island — is largely secluded from the rest of society. The nearest hospital is an hour and a half away.

Disaster has only compounded these challenges.

When Hurricane Maria hit the island in 2017, the Kalinago Territory was one of Dominica’s most severely affected communities. The Kalinago — whose livelihoods depend on farming and fishing — lost 80% of their crops and roughly two-thirds of homes were destroyed or damaged.

Despite the impacts of Hurricane Maria, the Kalinago didn’t receive much assistance in their recovery, according to Dan Hovey, Direct Relief’s Senior Emergency Response Manager. “In view of the support Direct Relief received for Hurricane Maria, it was important for us to address the under-resourced healthcare system in the Kalinago Territory by equipping the local health workers with the tools they need to provide care for their community.”

A “Clear Need”

In 2019, Hovey made a trip to Dominica to see how Direct Relief could help. There, he met with community leaders in the Kalinago Territory, including District Nurse Winnie Joseph.

“She knew every single person in the entire territory, their story, their health records, their children,” Hovey recalled.

While the territory wasn’t lacking in skilled health care personnel, there was a marked lack of health facilities.

When Hovey visited, the community only had two clinics, and the main health care facility, “was just completely empty,” he said. There were no exam tables, no diagnostic equipment, and few basic supplies, like bandages or gauze.

For anything urgent, people had to travel more than an hour to the nearest hospital. For the Kalinago — many of whom lack transportation — this was not always possible. There was a “clear need,” said Hovey.

Direct Relief’s Response

To ensure providers like Nurse Joseph have what they need to provide care, Direct Relief, in partnership with Medical Professionals on a Mission, outfitted the territory’s primary clinic with over $36,000 worth of critical equipment including exam tables, a birthing bed, EKG machine, oxygen tanks, a medical refrigerator, and surgical supplies.

The Salybia clinic, as it’s called, now serves the Kalinago Territory as an urgent care, a birthing center, and a primary care facility where patients can be seen for everything from chronic disease management to substance use treatment. Providers have cared for more than 700 residents since the center was equipped this summer.

In addition, a new birthing bed and maternal-child health care supplies have created a place for mothers to receive comprehensive pre and post-natal care. Since June, twenty-four babies have been safely delivered by Nurse Joseph at the center.

The clinic also offers educational resources. Weekly classes are held on diabetes management, infection control, and breastfeeding for new mothers.

Direct Relief staff, including Hovey, continue to be in communication with Kalinago community leaders and are prepared to assess additional needs for medical aid or support.